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SAN JOAQUIN <br />riAK~ COUNTY <br />— <br />`�qc,e`' Greatness grows her: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: �') c V <br />Facility Address: j <br />Well Address: <br />WP# Well#: <br />Soil Boring#: <br />Drilling Company: VV <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes *0 <br />Domestic Well Onsite: ❑ Yes �o <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 El N-6-1? <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: -4w-(-4-GLk fo <br />k4' ..4 <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From <br />Grout From <br />COMPLETION ❑ Stove Pipe <br />El Yes ❑No�� �'�°'� <br />D <br />❑ Yes El Nn D6 ' <br />V 3, 5, S <br />❑ Yes El No 11,' <br />To: <br />To: <br />To: <br />To: l A>7y✓ <br />❑Christie Box l �` <br />casing <br />IFflT height <br />79 -- <br />ABOVE -GROUND <br />% t �1 <br />OONFLETION -H <br />comPLEncisi <br />Ground SLwlwv <br />groLn <br />abtmd <br />&*&don <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: n - <br />Grout Material: <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationyBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />>�Q ravity ❑Tremie []Other: <br />Casing Type: <br />2 Blank Feet <br />Na e' 4;;;& Slot Size: <br />ej of Cement: <br />c'1�&eBags <br />Bags Sand/Gravel: <br />3'S�cic{ c -Q Type/Brand of Bentonite: _ <br />grA 1aY� Filter Pack Type/Size: <br />Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />izallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />tt Bags <br />Thickest Thinnest <br />b Bags <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 />3 <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 <br />8 <br />40 <br />80 <br />8 <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 />H2o ioo��u�,r� 20 h;s <br />,� Gll�,s s <br />1868 E. Hazelt n Avenue I St dfcton, Californr 9505 1 T 209 468-3420 1 F 209 464-0138 <br />�PH y-- <br />10/16/2017 <br />www.sucehd.com <br />