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10" <br />SAN JOAQUIN <br />Environmental Health Department <br />—COUNTY <br />Gr•ectness prows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: i 6 (I Inspector: CONSTRUCTION <br />Facility Address:0' ^ 1 k <br />Well Address: � O { I(L c j Total Depth: U <br /># 3 ' Well#: Drilling Rig Type: <br />Soil Boring#: —� 1�•� <br />n ingeCompany: Min 2" Annular EHD Seal Verified: ❑Yes ❑N <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 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <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 />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes 0 N <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: _JD— �, <br />Depth to Water: i 1•, g G� <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation .�❑Well Destruction <br />❑Boring Installation Loring Destruction <br />RACTUnn 1 rcGn <br />❑Pressure Grout []OverDrill <br />❑ Gravity )(remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />stBags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />20 40 <br />4 <br />12.5 <br />25 <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 />ft. <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 />ft. <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 2.821 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 />