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SAN JOAQUIN <br />--COUNTY <br />°quFbRaP� Greatness grows here. <br />Environmental Health Department <br />I(N <br />(�Monitoring Well/Soil Boring Inspection Report <br />Dater ID Inspector: <br />Facility Address: 1 O <br />Well Address: <br />WP# 00 Well#: <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: C fiC) NIG <br />Consultant: <br />Geologist:uok <br />� lni9 -y oS sc6y <br />Public Water System Onsite: ❑ Yes Y No <br />Domestic Well Onsite: ❑ Yes [Ao <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 />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />If yes, material: ����((�� <br />GROUTING or DESTRUCTION Total Depth: `T�1"i <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: ry <br />❑Well Installation ❑Well Destruction <br />Boring Installation ❑Boring Destruction <br />UFTNnn I IcFn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94lb <br />Bags <br />Thickest Thinnest <br />kBags <br />Thickest Thinnest <br />BBags <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 />11.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />1 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />1 70 <br />7 <br />20 <br />40_, <br />40 <br />1 80 <br />8 <br />rr1 N GTR l I r'TI rl IV <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND Ct4MSTY-80X <br />COMPLErfON COMPLETION <br />Ground sudaoe <br />gr1aft <br />n. <br />n. <br />f� A <br />= m <br />0 <br />Waited = c <br />Wecyon — B <br />gni pack <br />x <br />n - <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 1.41 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 />