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SAN JOAQUIN <br />----COUNTY- <br />- �0 ani -r- <br />Environmental Health Department Sy "� /n' <br />c hive <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 26 22 Inspector: Sct&vsi CONSTRUCTION <br />Facility Address: in Lua' <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: 1 C Min 2" Annular EHD Seal Verified: <br />Drilling Company: <br />0\wj�iO4' <br />❑ Yes []No <br />Driller Onsite: Screen Length From: To: <br />_ h i • `Q S Filter Pack From: To: <br />Consultant:--"Aw"e <br />Geologist: 4�, Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes E] No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes E] No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes El No <br />If yes, material: e <br />GROUTING or DESTRUCTION T tal Depth: 5 1 f <br />Depth to Water: n <br />Grout Material: <br />Gallons of Grout Used: r,� gCtiJ� . <br />U <br />[]Well Installation ❑Well Destruction <br />❑Boring Installation gBoring Destruction <br />nnrTunn i iccn <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />C ent 471b <br />Bas <br />Water <br />allons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />UA.s <br />Thickest Thinnest <br />b 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 />tL <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/Gement Mix 3% Mix 3% 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.sucehd.com <br />