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SAN JOAQUIN <br />COUN Ty <br />Greatness grows here <br />Environmental Health Department <br />�{ <br />Monitoring Well/Soil Boring Inspection Report <br />Date: t Ir <br />ector: Qj (, ' CONSTRUCTION <br />Facility Address: c 1) � _ 'f�p'r <br />Well Address: Total Depth:) <br />WP# 0CG W,II#: Drilling Rig Type: <br />Soil Boring#: ` 1 Min 2" Annular EHD Seal Verified: ❑ Yes []No <br />Drilling Company: <br />Driller Onsite: Screen Length From: To: <br />Filter Pack From: To: <br />Consultant: <br />Geologist: , ,N "Y (� Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />CAKAPI If\l(-, <br />Holding Temper Lure: <br />Method: <br />Screening Method: <br />Verified Chain of Custody <br />Njb-iaCr <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total D�pth:�,� gu, <br />Depth to Water: iv / <br />Grout Material: <br />Gallons of Grout Used:11 <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationBoring Destruction <br />MFTHr)r) I ICFr) <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />izallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />NBa s <br />Thickest Thinnest <br />4Bags <br />2.5 <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 />1 35 70 <br />20 40 <br />8 <br />1 40 80 <br />8 <br />casing <br />height <br />ABOVE-GIRCUND CNRSTY-BOX <br />C0M9LET;0N COMPLETION <br />G ound sumacs <br />o.«n <br />ft. <br />ft. <br />e <br />= o <br />_ o <br />alattad � ' <br />itsc:on — 3 <br />ft. 2 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.s'cehd.com <br />