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SAN JOAQUIN Environmental Health Department <br />--COUNTY— <br />rs,��r=`` Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: C30), Irl CONSTRUCTION <br />Facility Address:ProwirlhN <br />Well Address: Total Depth: <br />WP#ooH j q —") I Well#: Drilling Rig Type: <br />Soil Boring#: 6 I Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: <br />Driller Onsite: Screen Length From: To: <br />Consultant: <br />Filter Pack From: To: <br />Geologist: Chri S Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑No <br />SAMPLING <br />Cement 941b <br />Bags <br />Holding Temperature: <br />RBags <br />Thickest Thinnest <br />Method: <br />2.5 <br />5 <br />Screening Method: <br />5 <br />10 <br />Verified Chain of Custody: <br />❑ Yes <br />11 No <br />SPOILS <br />10 <br />20 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />15 <br />30 <br />Covered: <br />❑ Yes <br />❑No <br />If yes, material: <br />20 <br />40 <br />GROUTING or DESTRUCTION Total Depth:201 201 <br />Depth to Water: �Y�� ft. <br />Grout Material <br />Gallons of Grout Used: '`' 12V01-011 b0 ;rWV<, MATERIALS/DEVELOPMENT <br />j _ Casing Type: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />mens 411b <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />ttBags <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 1 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 1 <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 />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 />ft. <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.sacehd.com <br />