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6�Zc <br />u <br />1 " <br />z�° SANdOAQUIN <br />Environmental Health Department <br />Q <br />—COUNTY -- <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /�� 1 Inspector: v " ,/ 1 u CONSTRUCTION <br />Facility Address: 3 i50? Of 1�? 1�As,-v � <br />Well Address: -f'� 2(A Total Depth: '► .1 <br />WP# $)4) `,7i j D $� Well#: Drilling Rig Type: / <br />Soil Boring <br />Cement 471b <br />Bas <br />Min 2" Annular <br />EHD Seal Verified: <br />Drilling Company: <br />4Bags <br />Thickest Thinnest <br />Driller Onsite: <br />Screen Length <br />From: <br />Consultant:Filter <br />K <br />Pack <br />From: <br />Geologist: p eL� & <br />Bentonite <br />From: <br />Grout <br />From: <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 />❑ Yes ❑ No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes Vo <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total peatf} <br />Depth to Water: / �� <br />Grout Material: r;k nLS-4 <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installationyko ring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />%Gravity ❑Tremie ❑Other: <br />Water <br />gall! s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />ABags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />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 />ABOVE-GROLIND CiiAlM43OX <br />COMPLETION COMPLEMN <br />Ground Surlwe <br />grout <br />ft. <br />ft. <br />C <br />_ o <br />slotted <br />s�cson — B <br />7 = gravel pact <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.s4cehd.com <br />