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SAN:JOAQUIN <br />COUNTY— <br />Greotness grows here. <br />Monitoring Well/Soi <br />Date: Alpf' <br />ctor:Facility Ad r (114 q <br />Well Address: <br />WP# C'Q Well#: <br />Soil Boring#: — — 1 '� <br />Drilling Company: A .0.4 <br />Driller <br />` <br />Driller Onsite: <br />Consultant: C J <br />Geologist: , 1 Ir'C i S 5 y <br />Environmental Health Department <br />Boring Inspection Report <br />CONSTRUCTION <br />f <br />Total Depth: f <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />. From: <br />Grout <br />From: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe <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: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes El No <br />If yes, material: <br />r <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: N <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation <br />Destruction <br />❑., <br />❑Boring Installation <br />/Well <br />5X0 ring Destruction <br />METHOD USED <br />������//////��>�»..• <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />ailons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />s <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <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 />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRMTY-Sox <br />COLPLETION coMPLEnc)N <br />c round Sumacs + -- <br />grout <br />>Y - N <br />— r <br />— a <br />slotted - <br />sac5on "— <br />_ = VIVW PaCK <br />M — ft. <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 1.41 2.47 <br />Bentonite per 94 Ib 2.82 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.s*cehd.com <br />