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7 <br />SAN JOAQUIN Environmental Health Department <br />6 i4�;- `' --COUNTY--- <br />Greatness <br />—COUNTY - <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: (� 1 Ins pector:CONSTRUCTION <br />Facility Aclress: r <br />Well Address- Total Depth: <br />WP# "6 Well#: Drilling Rig Type: to I <br />Soil Boring#: Z 3 Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: <br />Driller Onsite: "�ira�,�.k �, (�J Screen Length From: To: <br />Consultant: L P—-tVor Filter Pack From: To: <br />Geologist: Pf AG Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes ANO COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes 'KNo <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 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: QO r <br />Grout Material: kle <br />Gallons of Grout Used: ` <br />❑Well Installation ❑Well Destructio <br />❑Boring Installation %Boring Destruction <br />METHOD USED <br />Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />Rall s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <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 1 <br />8 <br />casing <br />IT�T height <br />ABOVE -GROUND CHRISTY43OX <br />COMPLETION COMPLETION <br />Ground Surface T <br />grout <br />ft. <br />ft. <br />O <br />_ o <br />slotted c <br />on — 8 <br />r = gravel Pack <br />fL 21 =IFft. <br />MATERIALS/DEVELOPMENT <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 />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />