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SAN 10AQUIN <br />COUNTY <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: �)V CONSTRUCTION <br />Facility Address: _� �,Z A : Lfm YtJ 1� / <br />Well Address: Total Depth: 01 f Q <br />WP# © Well#: Drilling Rig Type. v 1/� <br />Soil Boring#: 2 <br />Drilling Company: 2ecKiii CUA Min 2" Annular EHD Seal Verified: El Yes El No <br />� �4� <br />Screen Length From: To: <br />Driller Onsite: �-�.4 1;� Filter Pack From: To: <br />Consultant: <br />Geologist: �� Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El 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 />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRISTY-BOX <br />COWPLETION COMPLETION <br />Ground Sumacs T <br />grout <br />ft. <br />ft. <br />ft. <br />_= o <br />Q w <br />�— <br />g 3to B 65 3) slotted _ B <br />(CoO&V-11 on <br />to ' b sn7 ". = Qrawl aavc <br />GROUTING or DESTRUCTIONTotalTotal Depth: g �'� __ <br />IF <br />Depth to Water: / A �E (ell )I',-rSA <br />Grout Material: CU <br />Gallons of Grout Used: / iVIHt t_nIMLJ/DEVELOPMENT <br />rasing Type: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation$(Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />'Gravity remie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />aBags <br />Thickest Thinnest <br />ttBags <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 />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 />Blank Feet Screen 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 />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 />