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SAN JOAQUIN <br />" L - —COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 12 t�3• Inspector:ttO CONSTRUCTION <br />Facility ddress: <br />Well Addr S PAG: <br />WP#�� �-. Well#: <br />Soil Boring#: ta <br />Drilling Company: <br />Driller Onsite: o <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes qNo <br />Domestic Well Onsite: ❑ Yes +o <br />If yes, location and distance: 1 <br />SAMPLXG <br />Holdinture: <br />Metho <br />ng Method: <br />Velfified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination oted: ❑ Yes El No <br />If yes, sp s storage Location: <br />Covere ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:i�, <br />Depth to Water: --- <br />Grout Material: Tr <br />Gallons of Grout Used: X!To q I Irm, <br />❑Well Installation ❑Well Destruction <br />�%oring Installation ❑Boring Destruction <br />nnFTunn I ICFn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie *her: � <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />kBags <br />Thickest Thinnest <br />Jt 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 />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Ve <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rntUal FTInN <br />From <br />m <br />❑ Stove Pipe <br />❑ Yes []No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />ITTLT height <br />ABOVE -GROUND CWtS1Y430X <br />COWLETION COMPLEnoN <br />Ground Surtan <br />grout <br />n. <br />n. <br />O <br />= o <br />— o <br />slotted = c <br />soon <br />on;+ s -k <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 />