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SANJOAQUIN <br />I' —COUNTY <br />Greatness grows here <br />:94�rattr;. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: J; 2 (0 / -/ Inspector: <br />Facility Address: <br />Well Address: <br />WP# Well#: <br />Soil Boring#: L/ %/ <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist:ew Ifl '1a-hryl, <br />Public Water System Onsite: <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />rnNCTRI irTInN <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnnnal FTlnnl <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRLM-aox <br />COWPLETION COMPLETION <br />(.hound surtac* <br />grout <br />n. <br />n. <br />n. <br />SPOILS ring! (aW K <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: `t /' ZZTT _. sbtt.e <br />TT sacdooft <br />n a <br />Covered: El Yes El No t;nw+P-* <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: l�� <br />Depth to Water: n <br />Grout Material: K'q n t Ce MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installationoring Destruction <br />MFTHnr) I ICFr) <br />❑Pressure Grout ❑Over Drill <br />'Gravity �Tremie E-1 other: <br />l <br />Waterment'471b <br />allons <br />Bas <br />water <br />allons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />xBags <br />Thickest Thinnest <br />9Bags <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 />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 />2-3bjs wl3gallou wa4trptr b4lj <br />fS2 + bj W/3 jliatt4v 1 6/ 017 �fj <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 />