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SAN =JOAQUIN <br />_COU NTY-- <br />ogrp1 Greatness grows here <br />Monitoring Well/Soi <br />Date: Ao// Inspector: a? <br />Facility A dress: a <br />Well Address: , <br />WP# Well#: <br />Soil Boring#: <br />Drilling Company: S ✓� <br />Driller Onsite: ,S �L'N �Q <br />Consultant: �� M <br />Geologist: <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 <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water: N14 I <br />Grout Material: tl -04, It <br />Gallons of Grout Used: 1 1 4 "�G�r►S <br />❑Well Installation ❑Well Destruction <br />El Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑�,Gravity <br />Pressure Grout ❑Over Drill <br />❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />uBags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />25 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />Environmental Health Department <br />Boring Inspection Report <br />rnNCTRI IrTlnN <br />Total Depth: 45ADrilling Rig Type: I l <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: 1 I <br />Bentonite From: To: l l <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />ft. <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 />