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SAN JOAQUIN <br />Environmental Health Department <br />---COUNTY----- <br />' Greatness grows her, <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ��� Inspector: arOl <br />Facility Address: j �A-3 ►J• Sl�W A.v� <br />Well Address: <br />WP#1-1 � 1 L' % Well#: <br />Soil Boring#: a I � �7l9 i 6 -it, f-�Q, +, C-5�3 <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: St e Ll <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 />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />CONSTRUCTION <br />Total Depth:____ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnnaal FTlnfu <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes []No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVEGROUND CHIRL 4= <br />COMPLETION COMPLETION <br />Ground Surface . <br />grout <br />ft. <br />ft. <br />ft. <br />_ a <br />allotted <br />atodon <br />_ = grawt pack <br />If yes, material:ttf Q-, 05� sk — <br />t 'C <br />GROUTING or DESTRUCTION Total Depth:Z Lj ZV <br />Depth to Water: n n' <br />Grout Material: <br />Gallons of Grout Used: -L t j�t MATERIALS/DEVELOPMENT <br />D <br />CT <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation�<Poring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />a Bags <br />Thickest Thinnest <br />a Bags <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 />30 <br />3 <br />10 20 <br />4 <br />40 <br />12.5 25 <br />5 <br />5 <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 />asing ype. <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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />