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SANJOAQUIN <br />0�7 —COUNTY <br />Greutness grows here. <br />Environmental Health Department <br />/ <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2 ('UZ- Inspector: V cl�l` c CONSTRUCTION <br />Facility Address: M StI S <br />Well Address: ) Total Depth: <br />WP#_0`) 4 3 L(Well#: — Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: <br />Drilling Company: K tTn iF7510 <br />❑ Yes ❑No <br />Driller Onsite: <br />Screen Length <br />From: <br />To: <br />Consultant: <br />oc Filter Pack <br />From: <br />To: <br />�� <br />Geologist: <br />Bentonite <br />From: <br />To: <br />1 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: <br />❑ Yes 11 No COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <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 <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION_ Total Depth: S <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: "— <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity '�fremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />41 Bags <br />Thickest Thinnest <br />liBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12,5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />casing <br />height <br />ASovE-GROUND CHRI IN -Sax <br />COWPLETION cOMPLE77oN <br />Ground Surfacs <br />grout <br />ft. <br />ft. <br />ft. _ <br />0 <br />i7 <br />= o <br />slotted = Z <br />sscdon = B <br />o-+ro+ Pack <br />F-MMENRL <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />Bentonite/Gement 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 />