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,Q <br />SAN 10AQUIN <br />C O U N T Y--.._. <br />� 1 <br />}c(,' Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date �0 r7 Inspector: CONSTRUCTION <br />Facility Address: <br />Well Address: A Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: Min 2" Annular EHD Se I r 'ed: <br />Driller Onsite: Screen Length !jOmv <br />To: <br />Consultant: Filter Pack To: <br />Geologist: Bentonite To: <br />Public Water System Onsite: ❑ Yes No <br />Domestic Well Onsite: ❑ Yes No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Metho <br />Verified Chain of Cust dy: ❑ Yes El No <br />SPOILS <br />Contamina on Noted: ❑ Yes El No <br />If yes, poils storage Location: <br />Cover ❑ Yes ❑ No <br />If es, material: <br />GROUTING or DESTRUCTION Total Depth: qt <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill W <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 />ttBags <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 />8 <br />40 <br />80 <br />8 <br />Grout <br />From; To: <br />COMPLETION ❑ S ove Pipe ❑Christie Box <br />ca ing <br />he'ght <br />A OVE-GROUND CHRLSTY4M <br />CONFLEMN COMPLETION <br />nd surrac* <br />grout <br />it. <br />fl. <br />tt. <br />C <br />SIC <br />grz+ w P-* <br />Casing Type: <br />Blank i Feet <br />Slot Size: <br />Bags of Cem nt: <br />Bags Sand/G avel: <br />Type/Brand f Bentonite: <br />Filter Pack ype/Size: <br />Type 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 />104(1 <br />17/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />