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SAN JOAQUIN <br />---COUNTY — <br />4, IFOR Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �Zf y Inspector: 107"tw <br />Facility Address: <br />Well Address: I GIY 6• Voad,,r&,d A.,N- <br />WP# 0:) Well#: <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite:�� <br />Consultant: <br />Geologist: M411. v <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />CANAPI INIr. <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />N <br />/J474' <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />IBags <br />Min 2" Annular EHD Seal Verified: <br />❑ Yes 0 N <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 />❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes 1:1 No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />�t <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: Z2 1 <br />Grout Material: N#4Ce*n"* <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />XPressure Grout ❑Over Drill <br />❑ Gravity �hTremie ❑Other: <br />Water <br />allons <br />rCe&nt 471b <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />IBags <br />Thickest Thinnest <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 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />1 70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />1 80 <br />8 <br />1 *- ,w fj" �3, p <br />1868 E`. zelton Avenue I Stockton, California 95205 <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 />T 209 468-3420 1 F 209464-0138 1 www.socehd.com <br />