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77 <br />°= SAN._,-JOAQUIN Environmental Health Department <br />COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Z Inspector: B(__U CONSTRUCTION <br />Facility Address: <br />Well Address: NQ -1 0Xf-C+,U WM y Total Depth: _ <br />WP#_ on 3e5 i J Well#: Drilling Rig Type: <br />Soil Boring#: In 2" Annular EHD Seal Verified <br />Drilling Company: +I� 1, <br />Driller Onsite: j Green Length From: <br />Consultant: ( Filter Pack From: <br />Geologist: Bentonite From: <br />Grout From: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes ❑No <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes 0 N <br />If yes, material: T <br />GROUTING or ESTRUCTION`Total Depth: <br />Depth to Water..— <br />Grout <br />ater:Grout Material: <br />Gallons of Grout Used: ' TP(M Wxf ` <br />v <br />❑Well Installation dell Destruction `< <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />'Aravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />R8111111 ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />x Bags <br />Thickest Thinnest <br />k 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 />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE-GAGUND CHFUS _Box <br />COM?LET;ON COMPLEr70N <br />Ground Svrtx+ <br />grout <br />ft. <br />S. <br />_ w <br />- O <br />slottQd - _ 3 <br />Bacon <br />A <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Tot 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 1,411 2.47 <br />Bentonite per 94 lb 2.821 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />a/� t I�J N'll�t� �{1t(�. <br />