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SAN�)OAQUIN Environmei Health Department <br />—COUNTY— <br />Greatness <br />COUNTY— <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ! b l Inspector: L.,— XL avu� <br />Facility Address: k0 W S Rrv-re,1JS– %.P!l <br />Well Address: <br />WP# Well#: C --t -`t,Z.J-;0 <br />Soil Boring#: <br />Drilling Company: PIWACC P- <br />Driller Onsite: K301�Qaea,J'acr✓�t <br />Consultant: Etl <br />Geologist: <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 />NOT.,IKI <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes ❑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 />GROUTING or DESTRUCTION Total Depth:{ , ?'SA" <br />Depth to Water:—3 2�ts n <br />Grout Material: QAC- <br />MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: Ito a . VbOA , 90a Casing Type: <br />❑Well Installation Ek(Nell Destruction Blank Feet <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED ��,�� <br />❑Pressure Grout L70ver Drill <br />❑ Gravity l4Tremie ❑Other: <br />Water <br />ailons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />1r Bags <br />Thickest Thinnest <br />tlBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />z <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <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.socehd.com <br />