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SANJOAQUIN Environmental Health Department <br />COUNTY <br />Greatness grows fiery <br />Monitoring Well/Soil Boring Inspection Report <br />Date: L?,,l Inspector: (�% L` CONSTRUCTION <br />Facility Address: a <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Drilling Company:le,cl-in;cor) <br />Screen Length From: To: <br />Driller Onsite: <br />Consultant: ) NAIIA —'Zrire✓r CC— Filter Pack From: To: <br />Geologist: 6,.-v C-2 Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No casing <br />If yes, location and distance: height <br />SAMPLING ABOVE -GROUND <br />Holding Temperature: CO�"P�ION c norXi <br />Method: G=nd Sumac <br />Screening Method: grout <br />Verified Chain of Custody: ❑ Yes ❑No—n' <br />tt. <br />SPOILS — <br />a;4 C <br />Contamination Noted: ❑ Yes El No = <br />If yes, spoils storage Location: atotrae <br />aacscn <br />Covered: El Yes ❑No I = g--4 Pack <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: iv - <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installatio"`3oring Destruction <br />not=Tann I KPI1 //'' <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Ceme 941b <br />Ba <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />#Bags <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 1 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <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 />—ft. <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 />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com <br />