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SAN JOAQUIN <br />—COUNTY- <br />9r,Faari':' Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: `t <br />Inspector: b«lk"- tL <br />Facility Address: I <br />LOLA1�x .L <br />Well Address: <br />VBags <br />WP# �� ��,i <br />Well#: <br />Soil Boring#: <br />Screen Length <br />Drilling Company: <br />a f -Z- - <br />Driller Onsite: i- <br />_ <br />Consultant: <br />Bentonite <br />Geologist: <br />u.!N <br />10 <br />Public Water System Onsite: <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />❑ Yes P'No <br />❑ Yes �lo <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes material: <br />CONSTRUCTION <br />Total Depth: <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Drilling Rig Type: <br />Thickest Thinnest <br />VBags <br />Min 2" Annular EHD <br />Seal Verified: <br />❑ Yes El No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND Ci-sim-BOX <br />COM?LETION COMPLETION <br />Ground sumac. <br />grout <br />�- ft. <br />n. <br />ft. <br />— o <br />slotted _ 8 <br />saclion <br />gnval pack <br />GROUTING or DESTRUCTION Total Depth:i? -2 (j t -Lc>l <br />Depth to Water: 3. , I n• IF IF <br />n' <br />Grout Material: <br />Gallons of Grout Used: -A- -Ro MATERIALS/DEVELOPMENT <br />C T <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation�Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 6Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />VBags <br />Thickest Thinnest <br />it Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 2 <br />2 <br />7.5 15 <br />3 <br />15 3 <br />3 <br />10 20 <br />4 <br />20 40 <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 />8 <br />40 80 <br />8 <br />asing ype. <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 />Sentonite 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.s*cehd.com <br />