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meSANdOAQUIN <br />) ' ',' COUNTY <br />c�^'rr P' Grr=afn= ss gro,s here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Cw <br />Date: (ZZ Inspector: C CONSTRUCTION <br />Facility Address: )Or 1) s 1 CC' � <br />Well Address: Total Depth: Do 30 <br />) <br />WP# r)Well#: I�✓—3 Drilling Rig Type, <br />Soil Boring#. Min 2" Annular EHD Seal Verified: <br />ElDrilling Company: V <br />Driller Onsite: Screen Length From: To: <br />Consultant:bi ((tee — 7(q h Filter Pack From. To. <br />Geologist:yatI.J4 Bentonite From: To: <br />Grout From: ! To: <br />Public Water System Onsite: El Yes <br />❑No <br />Domestic Well Onsite: ❑ Yes ❑ No <br />If yes, location and distance. <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑Yes ❑ No <br />SPOILS <br />Contamination Noted: ❑Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material. <br />GROUTING or DESTRUCTION Total Depth: If' / <br />Depth to Water Al . `� C,'� C.o i' na-rL <br />Grout Material: % ge y - <br />Gallons of Grout Used: -`� Gcou) <br />[RV <br />Uell Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />Water Cement 471b Water <br />allons <br />Bas <br />3°�° Niix <br />allons <br />Cement 941h <br />8a s <br />Thickest <br />Thinnest <br />#Bags <br />Thickest <br />Thinnest <br />#bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />1245 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />20 <br />35 <br />40 <br />7 <br />8 <br />35 <br />40 <br />70 <br />80 <br />7 <br />8 <br />Yes <br />❑No <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />alwre��ia+ <br />•PHa <br />l r <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size, <br />Bags of Cement. <br />Bags Sand/Gravel. <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size. <br />Type of Method. <br />Screen <br />Feet <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />I�ent�nitefOement tuli�c <br />3°�° Niix <br />S°�° Nlix <br />8�11tOrlltB per �-� 113 <br />'1.41 <br />2.47 <br />Bentonite <br />per 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />