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SAN J OAQ U I N Environmental Health Department <br />—COUNTY <br />-,.K Chea±ne•ss yrOvvS flare. <br />Monitpring Well/Soil Boring Inspection Report <br />/' <br />C) Date: / � �' Inspector: <br />',C <br />� 0 <br />CONSTRUCTION <br />Facility Address: ��-5-0�O <br />Thickest Thinnest <br /># Bags <br />Well Address: <br />WP# S; -t> <br />Well#: <br />Total Depth: ,.3) I <br />Drilling Rig Type: S � 6✓\ 4 Cl— <br />Soil Boring#: <br />1 <br />Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Drilling Company: <br />, <br />10 <br />Driller Onsite: <br />10 20 <br />Screen Length From: To: <br />Consultant: <br />Q <br />Filter Pack From: To: <br />Geologist: <br />3 <br />Bentonite From: To: <br />20 <br />4 <br />Grout From: To: <br />Public Water System Onsite: <br />❑ Yes El No <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑ No <br />If yes, location and distance: <br />CAI\API II\I(-, <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Toil Pepth: 190 <br />Depth to Water: I I b - Svc A <br />Grout Material: ( & <br />Gallons of Grout Used: X56) i <br />❑Well Installation ❑Well Destruction <br />❑Boring Installationeoring 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 />Rallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br /># Bags <br />Thickest Thinnest <br />4 Bags <br />2.5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />10 20 <br />2 <br />7.5 <br />15 <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 />1s <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 />WTcasing <br />height <br />ABOVE -GROUND Ci RISTY-BOX <br />CONF'LEr10N CCMPLEnCN <br />Ground Surta" <br />grout <br />ft. <br />ft. <br />ft. <br />. p= <br />C <br />slanad <br />s=.on — B <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 />L Bentonite per 47 Ib 1.41 2.47 <br />-! l� Bentonite per 94 Ib 2.82 4.7 <br />0 VeP" <br />I <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 />