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SAN JOAOUIN <br />" ' COU NTY--- <br />,yJL=`yl% <br />c9 rbdRNP Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: �� V ' CONSTRUCTION <br />Facility Address: <br />Well Addres C/ Total Depth: <br />WP# © Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: '�— Min 2" Annular EHD Seal Verified: <br />G <br />❑ Yes ❑ No <br />Driller Onsite: C � 1-4 <br />Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: t Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />SAMPLING �` `L - t' (h <br />Holding Temperature.: <br />Method: h ISS S S <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />@ISiN711M <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total epth: �I <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />G <br />[]Well Installation ❑Well Destruction <br />El Boring InstallatioXBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />he Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />izallons <br />Cement 941b <br />Bags <br />Thickest Thin <br />u <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />,ft. <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 />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.socehd.com <br />