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F SAN JOAQUIN <br />i_•4i —COUNTY— — <br />`.9,., Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date. `U Inspector: lTt �' CONSTRUCTION <br />Facility Address: <br />Well Address: Total Depth: <br />WP# A'31733 Well#: Drilling Rig Type: <br />Soil Boring#: is— <br />Drilling Company: <br />Driller Onsite: <br />Consultant: [�Ir <br />Geologist: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />r Filter Pack From: <br />�r <br />Bentonite From: <br />Grout From: <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 />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: (.Z - <br />Depth to Water: V�— <br />Grout Material: LA) t4 CkV.AAr <br />Gallons of Grout Used: -t <br />❑Well Installation ❑Well Destruction <br />El Boring Installation LNAoring Destruction <br />METHOD USED (( <br />❑Pressure Grout ❑Over Drill <br />;Gravity ❑Tremie ❑Other: <br />Water <br />gall s <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />NBags <br />Thickest Thinnest <br />tlBags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17. 35 <br />7 <br />35 <br />70 <br />7 <br />r-10.1 1 40 <br />40 <br />80 <br />8 <br />".w <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />wig <br />ABOVE -GROUND CH um-aox <br />COMPLETION COMPLE7ICN <br />Ground SmIlacs —+-- <br />praut <br />ft. <br />tt. <br />= r <br />ttottnd <br />section — B <br />_ = 9—W Pack <br />.Si <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 952051 T 209 468-3420 1 F 209 464-0138 1 www.sucehd.com <br />