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SANJOAQUIN <br />---COUNTY--- <br />Greatness <br />-COUNTY--Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: Vv CONSTRUCTION <br />Facility Address: <br />Well Address: Total Depth: <br />WP# � Q � SS Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: � Min 2" Annular EHD Seal Verified: <br />Driller Onsite: Screen 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 El 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 />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes El No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND <br />COMPLETION COMPLETION ('� CA <br />Ground sumac. <br />!-7 <br />yd s <br />grout <br />ft. <br />tt. <br />w <br />.totted = = COLS1 <br />sec.on — B <br />sante+ wxx <br />If yes, material: ?< <br />GROUTING or DESTRUCTION //Total Depth.- N 1 2F <br />=_ <br />Depth to Water: - •-M cc, �rvl�1 tt n <br />Grout Material: <br />Gallons of Grout Used: G% d5� MATERIALS/DEVELOPMENT <br />61 Casing Type: <br />❑Well Installation ❑Well Destruction ��js Blank Feet <br />❑Boring Installation �SlBoring Destruction r0L'L-"'tt Slot Size: <br />` Bags of Cement: <br />METHOD USED 7PS� �� �� y �c P Bags Sand/Gravel: <br />❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />❑ Gravity " Tremie ❑Other: Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gall ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />A Bags <br />Thickest Thinnest <br />b Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />IS 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />Screen <br />SO�bsv <br />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 />pate*, Qr;� J_ reek W p o o 3� 3!0 <br />C'ak d 'Qtrr C' ",,►e.tk, vih; c k -cell 4( ) h <br />ct,. , -,,b lzs�"oyed viii ,r VjQ d0 3 845i5 aS <br />4-\ -�M� <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 <br />F 209 <br />464-0138 <br />I www.sacehd.com <br />