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qa .: SAN�JOAQUIN <br />moi`=mac `j —COUNTY-- <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: <br />� <br />Inspector: & irtAv'� <br />CONSTRUCTION <br />Covered: ❑ Yes ❑ No <br />Facility Address: <br />VL <br />1 <br />ttBags <br />Well Address: <br />GROUTING or DESTRUCTION Total Depth: t0--1>, <br />Total Depth: <br />Depth to Water: Gvj- <br />WP# eAZ%a- <br />Well#: <br />Drilling Rig Type: <br />Gallons of Grout Used: j" Lira; ( � <br />Soil Boring#: ( <br />❑Well Installation ❑Well Destruction <br />7.5 15 <br />❑Boring Installationoring Destruction <br />TN <br />15 <br />METHOD USED <br />Min 2" Annular EHD <br />Seal Verified: <br />Drilling Company: <br />(s�f'�.zrV <br />40 <br />4 <br />Driller Onsite: <br />5 <br />Screen Length <br />From: <br />Consultant: <br />t A oLr j <br />Filter Pack <br />From: <br />Geologist: <br />ItM <br />Bentonite <br />From: <br />35 <br />70 <br />Grout <br />From: <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 />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes El No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />Cement 471b <br />Bas <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />Thi kest Thinnest <br />If yes, material: <br />1 <br />ttBags <br />.5 5 <br />GROUTING or DESTRUCTION Total Depth: t0--1>, <br />5 <br />Depth to Water: Gvj- <br />1 <br />Grout Material: 11J I1%,kk <br />[)q <br />Gallons of Grout Used: j" Lira; ( � <br />7� <br />❑Well Installation ❑Well Destruction <br />7.5 15 <br />❑Boring Installationoring Destruction <br />TN <br />15 <br />METHOD USED <br />3 <br />❑Pressure Grout ❑Over Drill <br />4 <br />`Gravity iTremie ❑Other: <br />40 <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thi kest Thinnest <br />Bags <br />Thickest Thinnest <br />ttBags <br />.5 5 <br />f <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 1.411 2.47 <br />Bentonite per 94 Ib 2.821 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 />