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SAN JOAQUIN <br />—COUNTY— <br />Environmental Health Department <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />�n <br />Date: � " 1 ^Inspector: <br />Facility Address: <br />Well Address: <br />WP# 2 Well#: <br />Soil Boring#: C� T , <br />Drilling Company: (-kw <br />Driller Onsite` au"V\- _ <br />Consultant:f le) l V\.1.(1.01 .LriG <br />Geologist: ' tb <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 />CONSTRUCTION 2"C PT <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: IZ� <br />Depth to Water: . W c, i, `J / <br />Grout Material: t�0 At 6 Yq/AT <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation NBoring Destruction <br />nnrTunn 1Icrn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity VTremie ❑Other: <br />Water <br />allons <br />m 471) <br />Basgallons <br />Water <br />Cement 94lb <br />Bags <br />Thickest Thinnest <br />4 Bags <br />Thickest Thinnest <br />b Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />1 <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 />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 />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 />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />