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SAN JOAQUIN <br />--COUNTY- <br />&eutness yov>s her. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:6 �I Inspector: (/`7��Q A- CONSTRUCTION <br />Facility Address: Q _ <br />Well Address: Total Depth: <br />WP# 0 S Well#: Drilling Rig Type: <br />Soil Boring#: R 11SN9 Min 2" Annular EHD Seal Verified: <br />Drilling Company: V1 <br />❑ Yes ❑ No <br />Driller Onsite: r Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: <br />Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe ❑Christie Box <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 />wn11 t <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: <br />I <br />GROUTING or DESTRUCTION Total Depth: I <br />Depth to Water: y1A— <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation �Zoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cemen <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />uBags <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 />2S 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 />tt <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 />n. <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonfte per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 11 T 09 468-3420 1 F 209 464-0138 1 www.s4cehd.com <br />