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SAN JOAQUIN <br />—COUNTY— <br />Greatness gro. s here. <br />Monitoring Well/Soil <br />Date:/ 1-IInnspector: <br />Facility Address: <br />Well Address: <br />WP#00aT4vWell#: i r -t - <br />Soil Boring#: <br />Drilling Company: r� <br />Driller Onsite: ps h <br />Consultant: L° <br />Geologist: <br />Public Water System Onsite: ❑ Yes []No <br />Domestic Well Onsite: eP-Yes []No <br />1 <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 />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: O <br />Grout Material: <br />Gallons of Grout Used: Ir <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout []Over Drill <br />❑ Gravity �T_remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />uBags <br />Thickest Thinnest <br />>ZBags <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 />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 />35 70 <br />7 <br />20 <br />4 <br />8 <br />40 80 <br />8 <br />u <br />Environmental Health Department <br />Boring Inspection Report <br />CONSTRUCTION <br />Total Depth:3Y_' <br />Drilling Rig Type: o §0") 56tt"'. <br />U <br />Min 2" Annular EHD Seal Verified: <br />Yes ❑No <br />Screen Length From:.30 <br />To: <br />Filter Pack From: 3 <br />To: <br />Bentonite From: 7 <br />To: <br />Grout From: <br />To:� <br />COMPLETION ❑ Stove Pipe Christie Box <br />�7 ft. <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: V V <br />Blank Feet Screen 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 />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 />