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SAN. JOAQUIN Environmental Health Department <br />COUNTY <br />Cireatnes yn:vs fier_. <br />Monitoring Well/Soil Boring Inspection Report <br />Date:/ /5//7 Inspector: L(%/. 6"--A4 <br />Facility Address: 3,372 t,). <br />Well Address: <br />WP# Well#: <br />Soil Boring#: l <br />Drilling Company: r--- <br />Driller Onsite: i' <br />Consultant: moi'/ .dsoj""' <br />Geologist: <br />Public Water System Onsite: ❑ Yes ANo <br />Domestic Well Onsite: ❑ Yes XNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes <br />, ❑ No <br />If yes, material: <br /># Bags <br />GROUTING or DESTRUCTION Total Depth:_ <br />t <br />Depth to Water: / <br />5 <br />Grout Material: AL-eeono <br />5 <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation>�Boring Destruction <br />METHOD USED <br />Pressure Grout ❑Over Drill <br />❑ Gravity gTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Fall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br /># Bags <br />Thickest Thinnest <br />4 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 />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 />CONSTRUCTION W <br />Total Depth: <br />Drilling Rig Type: <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 />A OVE-GROUND <br />COMPLETION COocmlMPpLETILEn N <br />ON <br />Ground Salaca <br />grout <br />�ft. <br />ft. ft. <br />0 <br />— o <br />sbttpd �: _ <br />aac�on = <br />ft. _IF <br />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 3% 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.socehd.com <br />