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SAN-JOAQUIN <br />1 r'tI `i —COUNTY <br />�C9l�FOP�P'" Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />1 <br />Date: Z Inspector: /; CONSTRUCTION <br />Facility Ad ress: 0' <br />Well Addres$ Total Depth/ <br />WP# Well#: Drilling Rig Type: : <br />Soil Boring#: \ a ` Min 2" Annular EHD Seal Verified: <br />Drilling Company: V�i <br />❑ Yes ❑ No <br />Driller Onsite: rralaGj Screen Length <br />From: <br />To: <br />Filter Pack <br />Consultant: It? 'h <br />From: <br />To: <br />Geologist: �} �.l Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <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 COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ANo <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 1 1O �. <br />Grout Material: N <br />casing <br />height <br />ABOVE -GROUND CHRM Y43OX <br />COMPLETION COMPLETION <br />Ground surlws <br />grout <br />tt. <br />ft. <br />0 <br />— a <br />stonad <br />aacion <br />gra <br />packj_ <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />[]Well Installation ❑Well Destructi Blank Feet Screen Feet <br />❑Boring Installation�Q Slot Size: <br />Boring Destruction Bags Size: <br />Cement: <br />METHOD USED <br />tPressure Grout ❑Over Drill <br />)(Gravity ❑Other: <br />1 Bags Sand/Gravel: <br />W <br />� Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />1-5 <br />Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />uBags <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 1 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 V <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 17 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 V <br />40 <br />80 <br />8 <br />1 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 />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />