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SAN JOAQUIN <br />--COUNTY— <br />,rrpUleS y'O'.va <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: '7j"3)11is- Inspector: "(&+C -n^ <br />Facility Address: .�O Liy GI.�r,Sr►v,� k of <br />Well Address: <br />WP# 0o'3 W24?, Well#: <br />Soil Boring#: R3 <br />Drilling Company: [itll Sige oul <br />Driller Onsite: <br />Consultant: <br />Geologist: h E%ef <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 />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: IUt <br />Depth to Water: K4C,Ai <br />Grout Material: &waL+-- cervet., t <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Noring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie 'Other: r«F �Q !/ <br />Water <br />allons <br />Cement 471b <br />Ba <br />Water <br />gallons <br />Cement 94lb <br />Bas <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2. 5 <br />1 <br />5 <br />10 <br />1 <br />10 <br />10 <br />20 <br />2 <br />7.5 15 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 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 />80 <br />8 <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVEGROUND CHRISTY43OX <br />CO&FLETION COMPLETION <br />Ground Sutan <br />grout <br />n. <br />n. <br />n. <br />w <br />— o <br />slotted = B <br />toclon <br />qr-.,W p..:k <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 952051 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />