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SAN 10AQUIN Environmental Health Department <br />COUNTY— <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report�� <br />Date: �� Inspector: vv C CONSTRUCTION LAP" <br />Facility Address: i Y 9 <br />42 <br />Well Address: Total Depth: ��r- � ' <br />WP# 0 Well#: Drilling Rig Type: �y,� 4-M <br />Soil Boring#: ' in 2" Annular EHD Seal Verified: ❑ Yes E]No <br />Drilling Company: I h (g <br />9 f <br />Driller Onsite: ��d ,'-(� reen Length From: To: <br />Consultant: a Y\ Filter Pack From: To: <br />Geologist: i i M s;+p 1 Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes El 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 />CPrlll C <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:_ (� <br />Depth to Water: 'Xi .Z, " <br />Grout Material: a aDd; <br />Gallons of Grout Used: r—n <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation <br />;4oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity [Aremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Sags <br />Thickest Thinnest <br />#Bags <br />Thickest 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 />In <br />2 <br />7.5 <br />15 <br />3 <br />15 L <br />30.g <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 />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 />� <br />L1 <br />V 1q -it <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix S% 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 />