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SAN.JOAQUIN <br />I• k%;. COUNTY-- <br />`�SrP' Greotness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />�/� <br />Date: l Inspect r: nA , �) CONSTRUCTION <br />F t 1 ilif Adre <br />d ss• S Y =Q 1A <br />acy <br />Well Address: b Total Depth: L��✓ l <br />r <br />WP# Well#: Drilling Rig Type: 1 <br />Soil Boring#: U✓ <br />Drilling Company: r `�'�''tMin 2" Annular EHD Seal Verified: EQ4ees ❑No <br />Driller Onsite: Screen Length From: To: <br />Con nt: AVuA = 141 Filter Pack From: N/ <br />Ist: Bentonite m. To. <br />Grout To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />cpnn r, <br />Contamination Noted: ❑ Yes ❑ No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes material: f <br />GROUTIN or DESTRUCTION T.kI Depth: <br />Dept to Water: <br />Grout Material: <br />Gallons of Grout Used: �� <br />,*ellInstallation ❑Well Destruction <br />,*ell <br />Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �Tremie ❑Other: <br />Water <br />allons <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />uBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <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 />E6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />—�c— casing <br />T height <br />ABOVE -GROUND <br />COMPLETION , <br />a <br />P <br />,7v3 <br />tt. <br />111Z 0 Ve&+P> PQ <br />CHRtm-BOX <br />COMPLETION <br />MATERIALS/DEVELOPMENT it <br />Casing Type: <br />Blank Feet Screen Feet V <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 />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 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.smcehd.com <br />