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SAN JOAQUIN <br />.—COUNTY— <br />Environmental Health Department <br />Greatness grows here. O n SI' -e- 4—') <br />Monitoring Well/Soil Boring Inspection Report <br />Date: � ZZ lnspector-:�\)Ovts CONSTRUCTION <br />Facility Address: 1 <br />Well Addr ss: Total Depth: <br />WP# Z Well#: Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: INI <br />Driller Onsite: Screen Length From: To: <br />Filter Pack From: To: <br />Consultant: <br />Geologist: t4 & 6 e— Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <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 />Covered: <br />If yes, material: <br />F-1 Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑NO casing <br />height <br />❑ Yes ❑ No i <br />❑ Yes ❑ No J <br />❑ Yes ❑Nor <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: A— <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />Boring Installation ❑Boring Destruction <br />ETHOD USED <br />❑Pressure Grout ❑Over Drill <br />1Gravity Ckreemire ) G <br />Z ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />vallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />uBags <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 />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />� '� <br />� <br />moi`• �% <br />a s <br />10 <br />r0 <br />Ground Sur w* <br />grout <br />�- re. <br />_ o <br />abttad <br />&*cion <br />cn,+ pak <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.s*cehd.com <br />