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SAN -J OA Q U I N Environmental Health Department <br />COUNTY <br />c9�P' Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: l Inspector: V" r CONSTRUCTION <br />Facility Address: 13 �3tt gzLt, led y� <br />Well Addr ss: l Total Depth: <br />WP#U� ':�' Z q Well#: Drilling Rig Type: <br />Soil Boring#: ® Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: 6Z r <br />Driller Onsite: -'� Screen Length From: To: <br />Consultant:llzr <br />Filter Pack From: To: <br />Geologist: r ��Nia_ Bentonite From: To: <br />Grout From: To: <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 />❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Totgl Depth: <br />Depth to Water: 1;S!? b <br />Grout Material: <br />Gallons of Grout Used: <br />caM--K� <br />MATERIALS/DEVELOPMENT <br />b`Casing Type: <br />❑Well Installation ❑Well Destru�on ;'5- c, ��Vlank Feet <br />lot Size: <br />❑Boring Installation *pring Destruction / gags Size: <br />Cement: <br />METHOD USED Bags Sand/Gravel: <br />l Type/Brand of Bentonite: _ <br />❑Pressure Grout ❑Over Drill Filter Pack TYp e/Size• <br />ElGravity �7remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />4 Bags <br />Thickest Thinnest <br />1l Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />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 />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 />5 J <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 <br />10/16/2017 <br />www.sacehd.com <br />