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SAN JOAQUIN <br />--COUNT Y <br />.ac�n <br />°q.,,o¢a`P' Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: y"lo"iz Inspector: lASc- L <br />CONSTRUCTION <br />Facility Address: (2jJceF k,,,� tyavl <br />Cement 471b <br />Bas <br />Well Address: <br />Total Depth: <br />Thickest Thinnest <br />W P # c )oLt3 12-2 Well#: <br />Drilling Rig Type: <br />4Bags <br />Soil Boring#: C PT- t 2, 3 <br />5 <br />1 <br />Drilling Company: An.��d�le >psxtf� <br />„ <br />Min 2 Annular EHD <br />Seal Verified <br />Driller Onsite: 2r <br />Screen Length <br />From: <br />Consultant: 3pr (o_c-f-t y- S ^s A A ss <br />Filter Pack <br />From: <br />Geologist: {� A JrQs <br />Bentonite <br />From: <br />10 <br />Grout <br />From: <br />Public Water System Onsite: ❑ Yes El No <br />COMPLETION <br />❑ Stove Pipe <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 E] No <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: jCj. S <br />Grout Material: N"'d r pyyO Vt <br />Gallons of Grout Used: //v <br />❑Well Installation ❑]Well Destruction <br />❑Boring Installation lJBoring Destruction <br />METHOD USED <br />❑Pressure Grout 0Over Drill <br />❑ Gravity r4remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />vallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <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 />❑ Yes El No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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.socehd.com <br />