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SANJOAQUIN <br />• —COUNTY <br />Greatness gravis stere. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 12,11,N1 I Inspector: `J <br />Facility Address: <br />-31 <br />Well Address: t� <br />WP# Well#: <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: lii'd <br />Consultant: -VXC.. <br />Geologist: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />❑ Yes <br />❑ Yes <br />Verified Chain of Custody ❑ Yes El No <br />SPOILS <br />Contamination to : ❑ Yes ❑No <br />If yes, spo' storage Location: <br />Covere • ❑ Yes ❑No <br />If s, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ASov'E-GROUND CHRI-m-sox <br />00hFLETION COMPLETION <br />[around Surlac• <br />grout <br />n. <br />ft. _ <br />o <br />0 <br />slotted <br />i•Gan = <br />_ V-91 pacts <br />R 2F <br />oe <br />Grout Material: <br />Gallons of Grout Used: ti MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation ❑Boring 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 />allons <br />94lb <br />BasThickest <br />Thinnest <br />4 Bags <br />Thickest Thinnestt <br />:Cement <br />Bags <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 1 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 1 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 1 <br />80 <br />8 <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 />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />4-1 �* `N n 14P4/ 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 />