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SAN JOAQUIN <br />—COUNTY - <br />Greatness grows hese <br />Environn,�ntal Health Department <br />�I Monitoring Well/Soil Boring Inspection Report <br />Date: t t' a�- Inspector: L��"r� CONSTRUCTION <br />Facility Address: V lJ�� <br />Well Address: - Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring #: <br />Drilling Company: l✓�y�l.�a Min 2" Annular EHD Seal Verified: <br />❑ Yes []No <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: <br />Bentonite From: To: <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 />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ,rNO <br />❑ Yes ON <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:—L5L---1-0 <br />Depth to Water: y\k--' <br />Grout Material: W <br />Gallons of Grout Used: LioSov"q pw <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation T54ring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />?'�ravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />trBags <br />2.5 5 <br />1 <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 />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />5o <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 />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑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 />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.s*cehd.com <br />