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SAN]OAQUIN <br />—COUNTY <br />— <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:.. Inspector: CONSTRUCTION <br />Facility Address: 2 <br />Well Address: Total Depth: <br />WP#_ U U LA 5 E Z0 Well#: Drilling Rig Type: <br />Soil Boring#: z Min 2" Annular EHD Seal Verified: <br />Drilling Company: � <br />❑ Yes ❑ No <br />Driller Onsite: <br />Screen Length <br />From: <br />To: <br />Consultant: —ADA/Filter <br />I <br />Pack <br />From: <br />To: <br />Geologist: <br />Bentonite <br />From: <br />To: <br />10 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes El No <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite <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 />❑ Yes ❑ No <br />If yes, material: <br />I <br />GROUTING or DESTRUCTION Total Depth: 5 �U <br />Depth to Water: L) ' <br />Grout Material: y1 <br />Gallons of Grout Used: (1-70 IF Cli <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation IKBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />ailons <br />Gement 471b <br />Bas <br />Water <br />Raill ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 1 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />8o <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 />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.sucehd.com <br />