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SANACA SAN.�JOAQUIN <br />Y— Environmental Health Department <br />Greatness grows here. <br />a <br />Monitoring Well/Soil Boring Inspection Report <br />Date: lol Inspect r: j�/►/(�jCONSTRUCTION <br />FacilityAddress: Rd - <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: - Min 2" Annular EHD Seal Verified <br />Drilling Company: i r✓O <br />Driller Onsite: lit �/,- �creen Length From: <br />Consultant:Filter Pack From: <br />Geologist: Bentonite From: <br />Grout From: <br />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes []No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <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 Depth: <br />Depth to Water: <br />Grout Material: 1il,Q &, - f�e�IWl�iVl.-fL <br />Gallons of Grout Used: 65 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Poring Destruction <br />METHOD USED <br />[]Pressure Grout ❑Over Drill <br />❑ Gravity Wremie ❑Other: <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />[]Christie Box <br />casing <br />height <br />IWT <br />AZOV;_-diROUND c l>srr aox <br />COkSPL1= n0lJ COMPLETION <br />Ground scrfacs <br />grout <br />ft. <br />fi. <br />tt. <br />- w <br />- — o <br />s[ottad _ <br />Waterement <br />gallons <br />47 <br />Bags <br />Water <br />gal III ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />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 />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 />BentonitefCement 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 />