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SANJOAQUIN <br />—COUNTY- - <br />Greatne>s grows <br />Environmental Health Department <br />(� Monitoring Well/Soil Boring Inspection Report <br />Date: I 2 3/ Inspector: W O'A <br />Facility Address: .12 Z"` l 3 WC)o cl <br />Well Address: <br />WP# 0O 3snq Well#: <br />Soil Boring#: t <br />Drilling Company: <br />Driller Onsite: <br />Consultant: (' r <br />Geologist: 6P "S S 0 <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />CAI\AP1 Inlr, <br />Holding Temperature: <br />Method: <br />Screening Method: <br />CONSTRUCTION 1 <br />Tota ept <br />deP/t 0 � <br />i �� <br />Drilling Rig Type: <br />(�6` Min 2" Annular EHD Seal Verified <br />D creen Length From: <br />C �ilter Pack From: <br />Bentonite From. <br />Grout From: <br />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />I <br />GROUTING or DESTRUCTION TotI Depth: <br />Depth to Water:61,11 <br />Grout Material: -eMNO-4 A <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation <br />oring Destruction <br />not=Tann 11143:111 <br />$❑Presre Grout ❑Over Drib B <br />2 3 meg► <br />Gravity XTremie ❑Other: <br />Water <br />gall s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />trBags <br />Thickest Thinnest <br />4Bags <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 />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 1 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 1 <br />40 <br />8 <br />40 1 <br />80 <br />8 <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 30/.Mix 5% Mix <br />Bentonite per 47 Ib 1 1.411 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />UU <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.sucehd.com <br />