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SAN JOAQUIN <br />'-i 1 COUNTY <br />Greatness grows her, <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: C) 22 Inspector: I CONSTRUCTION <br />Facility Address: i (- <br />Well Address: Total Depth: <br />WP#_C) 01 Z ��,� Well#: Drilling Rig Type: <br />Soil Boring#: -if <br />Drilling Company: a �v'1 <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Driller Onsite: Screen Length From: To: <br />Consultant: _ I4YckZ(U0. <br />Filter Pack From: To: <br />Geologist: CGXy'k(-) , I iWAQ !A Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑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 />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total DepthI �p <br />Depth to Water: + 31 <br />Grout Material: rv—U- <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 ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />k Bas <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Thickest ThinnestrB <br />Thickest Thinnest <br />1t Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />73— <br />35 70 <br />7 <br />10 40 <br />8 <br />40 80 <br />8 <br />ft. <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 />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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br />