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SANdOAQUINp <br />Environmental Health Department <br />COUNTY— <br />°9�k Greotness grow, her„. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ,1 Z1 ki- Inspector: -r 64;Yi , 7 04 -? CONSTRUCTION <br />Facility Address: (n10 !' <br />Well Address: <br />Total Depth: <br />WP# QD g336)?. `, 3& 7 Well#: <br />Drilling Rig Type: <br />Soil Boring#: V, A,,-1 (Zo ) 7r83 <br />(�Fi� w <br />Drilling Company: V CA w 'PL,yT_ <br />Min 2” Annular EHD Seal Verified <br />Driller Onsite: <br />Screen Length From: <br />Consultant:�f'a, C,rv�i�//�, �1 <br />Filter Pack From: <br />Geologist: <br />Bentonite From: <br />10 20 <br />Grout From: <br />Public Water System Onsite: ❑ Yes <br />El No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: <br />If yes, location and distance: <br />CAKAPI IN](-, <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 El No <br />❑ Yes ❑ No <br />If yes, material: <br />z •� <br />GROUTING or DESTRUCTION Total Depth: �-zo�V X 5G�n I <br />Depth to Water: 7.30 CP— <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 />fV1.Gravity ?SfTremie ❑Other: <br />0-% 4'04e <br />Water <br />allons <br />CementFb7 <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ABags <br />Thickest Thinnest <br />VBags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />I, ���a 130 LY -5 <br />1868 E. Hazelton Avenue I Stockton, California 95205 <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 />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 />T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />