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SANJOAQUIN Environmental Health Department <br />—COUNTY <br /><P'Greotness grows here <br />ltl"6 <br />Monitoring Well/Soil Boring Inspection Report <br />Date:ZI Inspector: CONSTRUCTION <br />Facility Address: 2 <br />Well Address: S �o�k��n Total Depth: —ZO / <br />WP# 00 3 940 Well#: Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Drilling Company: � \) �� <br />Driller Onsite: Screen Length From: To: <br />Consultant: Y`e, r-1,00-( Filter Pack From: To: <br />Geologist: jun Qa oto Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes IP�No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />P§No <br />SAMPLING <br />Cement 94 lb <br />Bags <br />Holding Temperature: <br />#Bags <br />Thickest Thinnest <br />Method: <br />2.5 <br />5 <br />Screening Method: <br />5 <br />10 <br />Verified Chain of Custody: <br />❑ Yes <br />El No <br />SPOILS <br />10 <br />20 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />15 <br />30 <br />Covered: <br />❑ Yes <br />❑ No <br />If yes, material: <br />20 <br />40 <br />GROUTING or DESTRUCTION` Total Depth: <br />Depth to Water: Niyy <br />Grout Material: CZA!Nl ,c$" <br />Gallons of Grout Used: 7 n <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Wring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />*Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallIll ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />4Bags <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 />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 1 <br />8 <br />40 <br />80 <br />8 <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND C.twtm-sox <br />COMPLETION COMPLETION <br />Ground skrtacs <br />01 grout <br />tt. <br />tt. <br />n. <br />_ o <br />= o <br />_ o <br />slotted <br />sac2on — <br />ix -v+ Pack <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.socehd.com <br />