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SAN 10AQUIN <br />i% �`` Environmental Health Department <br />lgt,�- --COUNTY-- -- <br />cqP..' Greotness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />CAIVIPI INr. <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑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:t <br />Depth to Water: <br />Grout Material: Wk±Lf,fi` rtt <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation *Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />RGravity ❑Tremie ❑Other: <br />Water <br />allons j <br />ement 171b <br />Bas <br />Water <br />gallons <br />Cement 94 ]b <br />Bags <br />Thickest Thinnest <br />Date: I212q ZI Inspector: <br />CONSTRUCTION <br />2.5 5 <br />1 <br />Facility Address: 01 <br />'lAhc . <br />S 10 <br />2 <br />10 20 <br />Well Address: <br />Total Depth: <br />15 30 <br />3 <br />WP# 0 U'� <br />Well#: <br />Drilling Rig Type: <br />4 <br />12.5 15 <br />Soil Boring#: \ - <br />25 50 <br />Min 2" Annular EHD <br />Seal Verified: <br />❑ Yes []No <br />Drilling Company: <br />6 <br />17.5 35 <br />7 <br />35 70 <br />Driller Onsite: � <br />�I.0 <br />Screen Length <br />From: <br />To: <br />i ' ° - <br />Consultant: i&( -4U4 <br />i> Lj <br />Filter Pack <br />From: <br />To: <br />Geologist: LG1.U(tr <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />Public Water System Onsite: <br />❑ Yes El No <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />CAIVIPI INr. <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑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:t <br />Depth to Water: <br />Grout Material: Wk±Lf,fi` rtt <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation *Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />RGravity ❑Tremie ❑Other: <br />Water <br />allons j <br />ement 171b <br />Bas <br />Water <br />gallons <br />Cement 94 ]b <br />Bags <br />Thickest Thinnest <br />ags <br />Thickest Thinnest <br />0Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />S 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 15 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 1 <br />8 <br />1 40 80 <br />8 <br />casing <br />height <br />ABOVE -GROUND CHRISTY43OX <br />COMPLETION COMPLETION <br />Grouro surf=+ <br />VA prart <br />tt. <br />tt. <br />M <br />= o <br />slottad c <br />sac�an — 3 <br />_ = gravel Pads <br />s <br />r = <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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />