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SAN JOAQUIN <br />—COUNTY— <br />Environmental Health Depart� <br />en <br />Monitoring Well/Soil Boring Inspection Report '3 > TO �A <br />Date: Inspector: Vv CONSTRUCTION �I,t <br />Facility Address: U04 1-kyo �1 <br />Well Add re Total Depth: �� 2 <br />WP# Well#: Drilling Rig Type. <br />Soil Boring#:1 !l) <br />Drilling Company: �in 2" Annular EHD Se Verified: 11 Yes ❑No <br />Driller Onsite: Screen Length From: To: <br />Filter Pack From: To: <br />Consultant: V_�_ IJ <br />Geologist: J t C, Bentonite From: To: (� <br />Grout From: To: J <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody <br />L14061l110 <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑Christie Box <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: Zo -1� /Lo St�21 <br />Depth to Water: A I.,Q n - <br />Grout Material: <br />Gallons of Grout Used: 5--v <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Nring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />9Bags <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 />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 />MATERIALS/DEVE LOPM ENT <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 />ft. <br />Screen Feet <br />Bentonite/Gement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />�7 10/16/2017 <br />1868 E. Belton Avenue I Stoc�ton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.socehd.com <br />