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SANJOAQUIN <br />—COUNTY ---- <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 3 �2 L2,611 Inspector: <br />Facility Address:_ 2-78113 <br />Well Ad[d�res <br />WP# 00 Well#: <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: WKAI <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />MeV1u10wro <br />❑ Yes ❑ No <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />❑ Yes ❑ No <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTI N Total Depth: 5C <br />Depth to Water: <br />Grout Material: uuj k- "1 'r0 ar <br />Gallons of Grout Used: <br />,.Well Installation Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />MCTunn I1CVn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity `u'Tremie ❑Other: <br />Water <br />allons <br />From: <br />Cement 471b <br />Bas <br />Water <br />gallons <br />From: <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ltBags <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 />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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />.casing <br />he ight <br />ABOVE -GROUND <br />C4-RLSTY43OX <br />.• - <br />it. <br />,TA fill daEAIMI11:04111�1]Ji19►r1 <br />Casing Type: <br />n. <br />Blank Feet Screen 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 />Bentonite/Cement Mix 3% Mix a% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />2j bis Qvu�gr�ut + Z� 5ct 6y1A vfa1x-o,- <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.s'cehd.com <br />