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ppuiN `-, <br />° SAN_ OAQUIN <br />2 Environmental Health Department <br />—COUNTY-- <br />�,:tcjgw`PJ Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />t-41 i <br />Date:0111)2A Inspector: 75allna.5 <br />Facility Address: <br />Well Address: <br />WP# () 0 q Well#: <br />Soil Boring#: rVO 1 <br />Drilling Company: 1�1 <br />Driller Onsite: i <br />Consultant: 1+4(4 a -A pfd tit A 'ThG. <br />Geologist: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />LW.,Ii•un,klrm <br />Holding Temperature: <br />Method: <br />Screening Method: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Verified Chain of Custody: ❑ Yes ❑No <br />rnNCTRI IrTInK] <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 />rnr%APl FTInIM <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHR ST 43OX <br />COMPLETION COMPLETION <br />Ground surtx. <br />grout <br />ft. <br />ft. <br />ft. <br />SPOILS w; <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: atoned <br />&*cion <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: r <br />Grout Material: `k <br />it lo <br />Gallons of Grout Used:M�F— MATERIALS/DEVELOPMENT <br />Casing Type: <br />XWell Installation ❑Well Destruction Blank Feet Screen Feet <br />❑Boring Installation ❑Boring Destruction,, <br />METHOD USED �vv <br />❑Pressure Grout ❑Over Drill <br />X Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />ment 471b <br />Bag <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />flea <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 <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 />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.s*cehd.com <br />