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SAN -J OAQ U I N Environmental Health Department <br />—COUNTY----- <br />Greatness grows here. <br />I II Monitoring Well/Soil Boring Inspection Report <br />Date: `zi�`Z� Inspector: lS, f� ` CONSTRUCTION <br />Facility Address: F -t 07 U �Z <br />Well Address: Total Depth: <br />WP# A:� 731' Well#: Drilling Rig Type: <br />Soil Boring#: 1 <br />Min 2" Annular EHD Seal Verified: ❑Yes El No <br />Drilling Company: 47,&\4- <br />Driller Onsite: Screen Length From: To: <br />Consultant: CZAR- A,.° O&L S Filter Pack From: To: <br />Geologist: nc+.Y,l� Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe ❑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 Po <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: t� <br />Depth to Water: ova <br />Grout Material: k&2 t'0 <br />Gallons of Grout Used: - �-o <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationZ'B-oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thi <br />t <br />&Bags <br />Thickest Thinnest <br />J1 Bags <br />2.5 <br />517 <br />5 10 <br />1 <br />5 <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 />casing <br />height <br />ABOVE -GROUND cHAlm-aox <br />COMPLETION comPt.ET10N <br />Ground sumac. <br />grout <br />tt. <br />ft. <br />m <br />— o <br />atottad <br />section - <br />c-+'+ v ­k <br />�x <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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />