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SKJ OAQ U I N Environmental Health Department <br />COUNTY- <br />- <br />OU NTY— <br />Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 12I2-�I l`k Inspector: &rkZr <br />Facility Address:9lo Plv. tvq,h�-e-c;o, <br />Well Address: <br />WP# 003"41ros Well#: <br />Soil Boring#: <br />Drilling Company: V t W 0c'% t\jyj% <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yeslo <br />❑ Yes *'No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes []No <br />GROUTING or DESTRUCTION Total Depth: IS <br />Depth to Water: No mer <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation)4Boring Destruction <br />METHOD USED <br />APressure Grout ❑Over Drill <br />.01 <br />ravity ❑Tremie ❑Other: <br />Water <br />Ilons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />90 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: Muc� <br />Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Screen Length From: <br />To: <br />Filter Pack From: <br />To: <br />Bentonite From: <br />To: <br />Grout From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND - C}{Ri5TY 80X <br />COMIPLETION COMPLETION <br />Ground SUrface <br />grout <br />ff. <br />it. <br />C <br />O � <br />stcttnd <br />tacdon A: <br />�: = grawi pads <br />IFft. <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 Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />