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SAN JOAQUIN <br />-COUNTY__ <br />oaP' Greatness grows here. <br />Environmental Health Department <br />ii <br />Monitoring Well/Soil Boring Inspection Report <br />l <br />Date: �nspector: V"0 CONSTRUCTION <br />Facility Address: i(7, CC Q ( y�5 <br />Well Address: Total Depth: � A <br />WP# Well#: Drilling Rig Type: } '[ <br />Soil Boring#: <br />��� Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Drilling Company: '�a` <br />Driller Onsite: Screen Length From: To: <br />Consultant: C Filter Pack From: To: <br />Geologist: 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 Sid"( � �t <br />Holding Temperature: <br />Method: b s 5 S 21z e s <br />Screening Method: <br />Verified Chain of Custody <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: <br />� ,r� t <br />GROUTING or DESTRUCTION Total Depth: c 0 S� <br />Depth to Water: De -\ <br />Grout Material: Y\ <br />Gallons of Grout Used: f� <br />❑Well Installation []Well Destruction <br />❑Boring Installation4Boring 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 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />tJBags <br />1.5 <br />CD <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 />-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 3% 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.s'cehd.com <br />