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2°A c2 SANAOAQUIN <br />� Environmental Health Department <br />" <br />—COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: 4,46Cew— <br />Facilit yAddress: Y4 Z3 i7/� ,j2nae. M,�- <br />Well Address: <br />WP#'209�5- WeII#: <br />Soil Boring#: <br />Drilling Company: ?"W'0-40 - <br />Driller Onsite: �<< <br />Consultant: <br />Geologist: �Owc <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 />SPOILS <br />Contamination Noted <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />rnMCTRI IfTI(1M <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />CYIMDI FTlnlU <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes El No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />wig —QWT <br />ABOVE -GROUND CHRIS'7Y-BOX <br />COMPLETION COMPLETION <br />Ground surface <br />grout <br />ft. <br />tt. <br />d: <br />If yes, spoils storage Location: 3 d / sbttad — <br />Y <br />Covered: El Yes ❑No Zbf i'on — t -LPA <br />If yes, material: , p•�h� t�� <br />GROUTING or DESTRUCTION Total Depth: it le %^` <br />Depth to Water: iJ n• <br />Grout Material: cc cone <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation D6oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />L3"Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />a ent 4 Ib <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />J: Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <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 />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 />ft. <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 />—s1868 E. Hazelton Avenue�Siockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com <br />