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z, SHAUN <br />Environmental Health Department <br />—COUNTY— <br />Sc(P' Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />/ <br />Date: u 6 Inspector: (i"rD CONSTRUCTION <br />Facility Address: /''J <br />Well Address: I t� r Z t t'IVv <br />Y/Total Depth: <br />WP# cc Well#: A' Drilling Rig Type: nZL C <br />Soil Boring#: ii` �K <br />Drilling Company: - . Min 2" Annular EHD Seal Verified: El Yes ❑No <br />Driller Onsite: ; Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: � 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 ❑No <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 ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 7,C) <br />Depth to Water: — (Z <br />Grout Material: ce <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />, <br />El Boring Installation*ring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 511remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />water <br />vallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />Bags <br />23 <br />5 <br />5 <br />10 <br />1 <br />S <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 />—ft. <br />n. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <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.socehd.com <br />