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SAN. JOAQUIN <br />--COUNTY-- - <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: I Inspe to I CONSTRUCTION <br />Facility Address:. D <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring Min 2" Annular EHD Seal Ver/ El Yes ❑No <br />Drilling Compan <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grnut From- To: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />CARAM int/ - <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Cu <br />cnnn c <br />❑ Yes No <br />❑ Yes No <br />❑ Yes ❑No <br />oted: <br />Conta/spoi <br />❑ Yes ❑No <br />If yorage Location: <br />water <br />gallons <br />Cover <br />❑ Yes ❑No <br />If yl: <br />Thickest Thinnest <br />GROUTING or DESTRUCTION Total <br />rr <br />Depth: <br />Depth to Water: <br />1 <br />Grout Material: <br />10 <br />Gallons of Grout Used: i <br />5 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation 413oring 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 />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />tlBags <br />Thickest Thinnest <br />NBags <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 />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <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 />s 1 <br />40 <br />so 1 <br />s <br />COMPLETION ❑ <br />cas�nq <br />height <br />ABOVE-GIR D <br />COMP ION <br />S� <br />V <br />abttad <br />soctcn <br />kx = <br />tt. <br />Pipe ❑Christie Box <br />-CFVT <br />Ci ffiLM-80X <br />COMPLETION <br />ti <br />praut <br />n. <br />tt. <br />A <br />C <br />0 <br />3 <br />9-91 Pack <br />n. <br />MATERIALS D VELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Ceme t: <br />Bags Sand/G vel: <br />Type/Brand f Bentonite: <br />Filter Pack T pe/Size: <br />Type of Met od: <br />Bent nite/Cement Mix 3% Mix 5% Mix <br />Bent nits per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />z <br />` Cil <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.s4cehd.com <br />