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�uuiro -.,4 <br />SANJOAQUINO Environmental Health Department <br />—COUNTY- <br />Greotness grows here <br />Monitoring/Well/Soil Boring Inspection Report <br />Date5�1 Ins ctor� 0Y" � A - CONSTRUCTION <br />Facility Address: (to <br />Well Address: <br />WP# Well#: <br />Soil Boring#: <br />Drilling Company: p --- <br />Driller Onsite: <br />Consultant:/YI ✓l�lo ce ore— <br />Geologist:Q�ttro— <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />qAKAPI Mir, <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 />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes El 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 />❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑ No <br />❑ Yes []No <br />❑ Ye <br />casing <br />height <br />ABOVE -GROUND CHRI- Y -BOX <br />00WLErION COMPLETION <br />Ground surf=* <br />grout <br />tt. <br />tt. <br />s ❑ N o =` — <br />= o <br />stottad <br />sac -,ion: — <br />❑Yes ❑ No = gra-4 s --k <br />If yes, material: �^ L <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 2'D �—Z -r— <br />Grout <br />rGrout Material: Lel�v <br />Gallons of Grout Used: 02.0 Q� <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation'�Poring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity KTremie ❑Other: <br />Water <br />allons <br />Cemen 71b <br />Ba <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />trBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <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 />�2 IDA 3 10 0-S <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 <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 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 />T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />