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M�X <br />SAN JOAQUIN <br />" -----COUNT Y— <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring ring Well/Soil Boring Inspection Report <br />wDate: l+' v I pect r: o I CONSTRUCTION i I <br />Facility Address: - <br />Well Address: Total Depth: <br />WP# Well#: ,, Drilling Rig Type: O c� <br />Soil Boring#: 81 1 B20 5') 3 �� `} <br />Drilling Company: cC2v 1 Min 2' Annular EHD Seal Verified <br />Driller Onsite: � J Screen Length From: <br />Consultant: Filter Pack From: <br />Geologist: Bentonite From: <br />Grout 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 E] No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />o' si�Q ABO -VE -GROUND <br />IG!-ffaiBTY-BOX <br />l p /� COMPLETION COMPLETION <br />j , c;ra,� s�rtx. <br />N1 . ^` grout <br />Sv <br />ft. <br />ft. <br />sbttod <br />aKson <br />IA= a -+o+ Pack <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: I5 -2S b <br />Depth to Water: co,," <br />Grout Material: <br />Gallons of Grout Used: _ 0 — S <br />❑Well Installation []Well Destruction <br />❑Boring Installation�413oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />9Gravity ❑Tremie ❑Other: <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 />ft. <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.socehd.com <br />