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SAN JOAQUIN <br />COUNTY- <br />`-i,,grows he,,. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: a 3 i %I Ins ec or: {� <br />Facility Address.ZZ b <br />Well Addres <br />WP# Well#: Z <br />Soil Boring#: `r <br />Drilling Company:,kj1'�A <br />Driller Onsite: <br />Consultant: <br />Geologist: n!w--ki <br />Public Water System Onsite: ❑ Yes 40 <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 Cust d ❑ Yes ❑No <br />SPOILS <br />Contaminatio oted: ❑ Yes ❑No <br />If yes, s oils storage Location: <br />Cover d: ❑ Yes ❑ No <br />yes, material: a <br />GROUTING or DESTRUCTION Tot Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: 3 <br />❑Well Installation ❑Well Destruction t)<4&f <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />From: <br />Cement 471b <br />Bas <br />Water <br />Rallons <br />From: <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />NBags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />s <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 />is <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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type:�QI(�17 �� �� " (f,/ <br />�� <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑Wc <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 />COMPLETION ❑ Stove Pipe ❑Ch/listie Box <br />Casing Ty <br />Blank _ <br />Slot Size: <br />Bags of ment: <br />Bags Sa d/Gravel: <br />Type/ rand of Bentonite: <br />Filter ack Type/Size: <br />Tvp 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 209 468-34201 F 209 464-0138 1 www.socehd.com <br />