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SAN.DJOAQUIN <br />w COUNTY— <br />cq«P � Greatness grows here <br />i Monitoring Well/Soi <br />Date: 2� 21 Inspector: knG <br />Facility Address: �a� �ii1'CO(f [NC1v1 <br />Well Address: <br />WP# 00256\ Well#: <br />Soil Boring#: !S(QV I +Q <br />Drilling Company: I&Of.r <br />Driller Onsite: <br />Consultant: �� G �G Ni�tNC�►'1CJI . <br />Geologist: <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes EJ 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 El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />Environmental Health Department <br />Boring Inspection Report <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />GROUTING or DESTRUCTION Total Depth:_ 1 T F�1i JV11 'ZOi <br />Depth to Water: � � f Jnr)), i A.' i, I n• <br />Grout Material: <br />Gallons of Grout Used:ScAQ)i 154(4 �2(j . <br />❑Well Installation ❑Well DestructionAir ❑Boring Installation ,� ring Destruction �,�� � J <br />METHOD USED <br />❑Pressure Grout ❑Over Drill . <br />❑ Gravity RTremie ❑Other: <br />Water <br />allons <br />ment 471b <br />Ba <br />Water <br />allons <br />Cement 941b <br />Sags <br />Thickest Thinnest <br />'V Sags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />17.5 35 <br />20 40 <br />6 <br />7 <br />8 <br />30 60 <br />35 70 <br />40 80 <br />6 <br />7 <br />8 <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.s*cehd.com <br />