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R= SAN 10AQ U I N Environmental Health Department <br />" iL-01" .`• COUNTY <br />car e, Gieutness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: <br />Facility Address: f <br />Well Address: fq (2L4 W t9Y z-✓/1fLL <br />WP# " ' rye Well#: 1 <br />Soil Boring#: j h LY, <br />Drilling Company: f7j,4 <br />Driller Onsite: <br />Consultant: C <br />Geologist: �by� <br />CONSTRUCTION <br />t� <br />Total Depth: <br />Drilling Rig Type: w c4 <br />Min 2" Annular EHD Seal Verified: ❑ Yes 11 No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />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 />--tj <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: i <br />Depth to Water: `o ^ IZ <br />Grout Material: --c <br />Gallons of Grout Used: 51- <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation �0ring Destruction <br />METHOD USED // `` <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity '�Tremie ❑Other: <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 5% Mix <br />Bentonite per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 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.secehd.com <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thinnest <br />tt i <br />Thickest Thinnest <br />NBags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />10 20Z <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />1010 <br />10 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 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 />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 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.secehd.com <br />