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L111� . <br />� = SAK,,JOAQUIN <br />—COUNTY Environmental Health Department <br />Qrr4' Greutness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: k Inspector: U < CONSTRUCTION <br />it <br />la,) Address: ( Y• n L T ,) ✓' ' <br />Well Address: Total Depth: <br />WP# GCS 7 31L75 Well#: Drilling Rig Type: <br />Soil Boring#: 3 U Ji <br />�(� w Min 2" Annular EHD Seal Verified: ❑Yes El No <br />Drilling Company: `. <br />Driller Onsite: <br />Screen Length From: To: <br />Consultant:Filter Pack From: To: <br />Geologist: 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 />❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />conn c <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes 1:1 No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:. Z� b <br />Depth to Water:9/ <br />Grout Material: � Ca1'7 <br />Gallons of Grout Used: 3o —1 a <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation)Boring Destruction r'61 <br />METHOD USED A&I.AMp <br />❑Pressure Grout ❑Over Drill �fk�;t) <br />❑ Gravity tSfremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Bentonite per 47 Ib 1.41 <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest <br />Thinnest <br />7Bags <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 />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />casing <br />height <br />ASoNE-GROUND CHRISIY-BOX <br />COMPLETION cOMPLEnoN <br />Ground sumacs <br />grout <br />ft. <br />ft. <br />ft. <br />o <br />= O <br />slotted, <br />sac�on y <br />. _ >-k <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 <br />5% Mix <br />Bentonite per 47 Ib 1.41 <br />2.47 <br />Bentonite per 94 Ib 2.82 <br />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.smcehd.com <br />