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SANIIOAQUIN <br />WW­—COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />MonitoringW{,ell/Soil Boring Inspection Report <br />Date: .Z,lnspe tor: RA > CONSTRUCTION <br />Facility Ad res :y <br />Well Address: Total Depth: <br />WP# L " Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: Min 2" Annular EHD Seal Verified: <br />Driller Onsite: Screen Length From: <br />Consultant: Filter Pack From: <br />Geologist: Bentonite From: <br />Grout From: <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: ❑ Yes 11 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: ❑ Yes E] No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: Y� <br />Grout Material: <br />Gallons of Grout Used: 0A U 5-2 61 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation A.Boring Destruction <br />❑Pressure Grout ❑Over Drill <br />KGravity ❑T7e� ❑Other: <br />Water <br />gallons <br />ment 471b <br />Bas <br />Water <br />eallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest#B <br />Thickest Thinnest <br />Jt 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 1 <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 1 <br />8 <br />40 80 i <br />8 <br />casing <br />height <br />ABOVE -GROUND CHRISTY43OX <br />COMPLETION COMPLETION <br />Ground Sudacs <br />grout <br />ft. <br />III = a <br />_ <br />.totted = a <br />soman <br />ni V I jr = graviol pack <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 />r <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 />