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SAN 10AQUIN <br />Environmental Health Department <br />COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: [1512k Inspector: <br />Facility A dress. <br />CONSTRUCTION <br />Well Address: Total Depth: <br />WP# o 0 Well#: p,�-� D illin Ri fTpe: <br />Soil Boring#: 'j, Z7Jt� urt Drilling Company:Min2 nar EHD Seal Verified: ❑Yes ❑No <br />Driller Onsite: Screen Length From: To: <br />J Filter Pack From: To: <br />Consultant: � � <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />CAKAPI INC, <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 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />casing <br />height <br />—Ef WT <br />ABOVE -GROUND ctwim-sox <br />COWPLEr10N coMPLEnoN <br />Ground stirla" + <br />grout <br />ft. <br />tt. <br />ft. <br />v _ � <br />m <br />= r <br />= n <br />slottad <br />soon _ • –' B <br />_ = cn+I+ POCK <br />GROUTING or DESTRUCTION Total Depth:151 (u1�1�5I 51 / � ISI <br />Depth to Water: d n• n' <br />Grout Material: L <br />Gallons of Grout Used: n, MATERIALS/DEVELOPMENT <br />Casing Type: <br />[]Well Installation []Well Destruc Ion J Blank Feet <br />Ell Boring Installation Moring Destruction <br />MFTWnn I lcF:n <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 'KTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Fallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />NBags <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 />15 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 />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/Gement 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 />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />