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-;; SAN JOAQUIN Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <br />Monitori Well/Soil Boring Inspection Report <br />?,���7i InspectorNlftM : CONSTRUCTION <br />ss: <br />/ Total Depth: <br />e: <br />Public Water System Onsite: <br />f0 Yes []No <br />Domestic Well Onsite: <br />Elf Yes No <br />If yes, location and distance: <br />Date: <br />Facility Addr <br />SAMPLING <br />#Bags <br />Holding Temperature: <br />Well Address: <br />Method: <br />1 <br />Screening Method: <br />WP# Z fn'O Well#: A) 116Drillin <br />Ri T g g yp <br />El Yes El No <br />7.5 15 <br />Soil Boring# — (— <br />Min 2" Annular EHD <br />Seal Verified: <br />El Yes 1:1 No <br />Drilling Company: '� 6Fi Q <br />20 40 <br />4 <br />12.5 25 <br />Driller Onsite: t� <br />Screen Length <br />From: <br />To: <br />Consultant: ON ON G <br />Filter Pack <br />From: <br />To: <br />Geologist: f c <br />Bentonite <br />From: <br />To: <br />a <br />Grout <br />From: <br />To: <br />Public Water System Onsite: <br />f0 Yes []No <br />Domestic Well Onsite: <br />Elf Yes No <br />If yes, location and distance: <br />#Bas <br />SAMPLING <br />#Bags <br />Holding Temperature: <br />Method: <br />1 <br />Screening Method: <br />2 <br />Verified Chain of Custody: <br />El Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: El Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: �O <br />Depth to Water: \S' <br />Grout Material: a'C <br />Gallons of Grout Used: (t7�aA <br />❑Well Installation ❑Well Destruction <br />El Boring Installation�Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity C�Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bas <br />Thickest Thinnest <br />#Bags <br />2.5 <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 />7 <br />35 70 <br />7 <br />20 40 <br />a <br />40 80 <br />8 <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />it <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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.co <br />