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SANJOAQUIN <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 1/ / Inspector: I✓,dSEEM <br />Facility Address: 44l4 S• 144,41 h, /3 re. <br />Well Address: <br />WP# X 3,;? f C/9� Well#: <br />Soil Boring#: $i <br />Drilling Company: G�� <br />Driller Onsite: <br />�Ov�G <br />Consultant: 4t_4_ <br />Geologist: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑ Yes <br />CA'No <br />.<N0 <br />SAMPLING <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />Holding Temperature: <br />Thickest Thinnest <br />4 Bags <br />Method: <br />5 <br />1 <br />Screening Method: <br />1 <br />5 <br />Verified Chain of Custody: <br />❑ Yes <br />El No <br />SPOILS <br />7.5 <br />15 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />20 <br />4 <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: /g/ <br />Depth to Water: /10 GG✓ <br />Grout Material: i1%.-leonew ' <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation f(Boring Destruction <br />MFTNnn I KM <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie )QOther: /GW,41/ <br />Water <br />allons <br />From: <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />4 Bags <br />Thickest Thinnest <br />4 Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />rnNCTPI IrTMIU <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 />ABOVE -GROUND CHRISTY-BOX <br />OOMPLEfION COMPLE71ON <br />Ground Surface — <br />grout <br />tt. <br />tt. <br />= e <br />_ o <br />.lotted <br />eec�on <br />_ = g-ve, Pack <br />tt.F tt. <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/Gement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />7-5-844W"+ 10/16/2017 <br />117.0 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />