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SANAOAQUIN <br />Environmental Health Department <br />—COUNTY---- <br />�eg4r/ Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2\ Inspector: CONSTRUCTION <br />Facility Address: <br />Well Address: N V1 Total Depth: <br />WP# ted , C) Well#: Drilling Rig Type: <br />.r��_ <br />Soil Boring#: a i�,t I Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: <br />Driller Onsite: �j,Prce b Screen Length From: To: <br />Filter Pack From: To: <br />Consultant: <br />yk I <br />Bentonite From: To: <br />Geologist: V1 p <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑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 '1Alo <br />If yes, spoils storage Location: (( <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: +IJ e <br />casing <br />height <br />ABOVE -GROUND CHR:STY-box <br />COMPLETION COMPLETION <br />Ground Surf acs <br />grout <br />tt. <br />it. <br />tt. <br />abtta0 _ � <br />aeon <br />= craviW pack <br />it. =IF -ft. <br />Gallons of Grout Used: /l. t O+'I MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br />Slot Size: <br />❑Boring Installation C Boring Destruction t5( X151 Bags of Cement: <br />METHOD USED `7t' ` �j5`� ags Sand/Gravel: <br />❑Pressure Grout ❑Over D II `5w Z.-�� ype/Brand of Bentonite: <br />�J� � 5 F Iter Pack Type/Size: <br />❑ Gravity *emie Other: T pe 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 />TS <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.socehd.com <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />vallons <br />Cement 94 lb <br />Bags <br />!K4st <br />Thinnest <br />#U s <br />Thickest Thinnest <br />#Bags <br />5 10 <br />1 <br />10 <br />10 20 <br />2 <br />7.5 <br />15 1 <br />3 <br />15 30 <br />3 <br />10 <br />20 1 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <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 />TS <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.socehd.com <br />