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w SAN 10AQUIN <br />,,5Jo —COUNTY--- <br />�+,''I Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date..J �1 Ins ector: �f O� - CONSTRUCTION <br />Facility A dress: D Ay7 <br />Well Address: Total Depth: <br />WP# 00 LIAJ14 Well#: Drilling Rig Type: <br />Soil Boring#: <br />o►��g Min 2" Annular EHD Seal Verified: <br />Drilling Company: <br />❑ Yes ❑No <br />Driller Onsite: <br />Screen Length <br />From: <br />To: <br />Consultant: /V';4 yoo►r� <br />Filter Pack <br />From: <br />To: <br />Geologist: LQ,aeti <br />Bentonite <br />From: <br />To: <br />1 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes El No <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <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: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: n <br />GROUTING or DESTRUCTION Total De the <br />Depth to Water: i <br />—.2 <br />n - <br />Grout Material: <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation Soring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 'rXremie ❑Other: <br />Water <br />pall <br />Cement 471# <br />Baz <br />water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />it Bags <br />Thickest Thinnest <br />#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 />1 <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 />12yH 3bjs <br />1868 E. Hazelton Avenue I Stockton, California 95205 <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 />10/16/2017 <br />T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com <br />