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SANJOAQUIN <br />COUNTY— Environmental Health Department <br />Greatness grows here. <br />M9,9itoring Well/Soil Boring Inspection Report <br />uyy <br />Date: � �� Inspector. �1 <br />Facility Address: �� �02 t > <br />Well Address: 4 Total Depth: <br />WR# 00 t-( Well#: y� Drilling Rig Type: <br />Soil Boring#: $� ZZ V�� Min 2" Annular EHD Seal Verified: ❑ Yes L1 No <br />Drilling Company: f v <br />Driller Onsite: L Screen Length From: To: <br />Consultant: 1 ' Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes XNo <br />Domestic Well Onsite: ❑ Yes l(N0 <br />If yes, location and distance: <br />cannpl Inl(. <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 />❑ Yes ❑No <br />❑ Yes El No <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHR&S N43Ox <br />COWPLETION COMPLETION <br />Ground Surface <br />proof <br />R. <br />ft. <br />ft. _ <br />4 � C <br />— o <br />slotted <br />sacon <br />Covered: ❑ Yes LIN <br />= gravel Pack <br />If yes, material: F 2Z <br />GROUTING or DESTRUCTION Total Depth: 1� 0 P G =_ <br />Depth to Water: Y n- tt' <br />Grout Material: 1, <br />Gallons of Grout Used: <br />❑Well Installation AWell Destruction <br />❑Boring Installation�98oring Destruction 1 <br />METHOD USED <br />Of ressure Grout ❑Over Drill <br />it �❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94lb <br />Bags <br />Thickest Thinnest <br />11 Bags <br />Thickest Thinnest <br />4Bags <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 />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />LIMA <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />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 />