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,- SAN 10AQUIN Environmental Health Department <br />—COUNTY <br />j_.N P`,UI"ZG�ilC55 yl'O iiS �Ei'f. <br />l.� p Molniit�oring Well/Soil Boring Inspection Report C7✓` �;.,�� <br />Date: 0 Inspector: ✓v CONSTRUCTION 2 ' bd M <br />Facility Address: — a4�f S ,-t 0 - <br />Well <br />Well Address: J Total Depth: L+- ,, D <br />WP# d D ZQn_Well#: Drilling Rig Type: SA J <br />Soil Boring#: <br />Drilling Company: <br />Min 2" Annular EHD Seal Verified: ElYes ❑No <br />Driller Onsite: Screen Length From: To: «"C/ <br />Consultant: 0 <br />Filter Pack From: To: <br />Geologist: r Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />CANAPI Inlr <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 El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes 11 No <br />❑ Yes ❑No <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Pa/eAth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationABoring Destruction <br />nnt=TNnn i KIM / \\ <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br />tlBags <br />Thickest Thinnest <br />1) Bags <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 />40 <br />80 <br />8 <br />2j L/ <br />❑Christie Box <br />1111111111MENMg@ <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 />ft. <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.s4cehd.com <br />