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SAN;JOAQUIN Environmental Health Department <br />—COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Public Water System Onsite: ❑ Yes []No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />connpl Inl(.- <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes E] No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: Vwwwt <br />Gallons of Grout Used: 5* <br />❑Well Installation C�Kkell Destruction— )A <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />r5d Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />` <br />Date: <br />—mess: � <br />Inspector: Cy l `l' <br />Facility A <br />LD ) -b W 16r <br />Well Address: <br />w✓ <br />W P# <br />Well#: <br />Soil Boring#: - <br />1 <br />Drilling Company: <br />2 <br />Driller Onsite: <br />2 <br />Consultant: <br />3 <br />Geologist: <br />wt� <br />Public Water System Onsite: ❑ Yes []No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />connpl Inl(.- <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes E] No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: Vwwwt <br />Gallons of Grout Used: 5* <br />❑Well Installation C�Kkell Destruction— )A <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />r5d Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />vallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />kBags <br />Thickest Thinnest <br />trBa s <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 1 70 <br />7 <br />20 40 <br />8 <br />40 1 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />—z— casing <br />T height <br />ABOVE -GROUND CtiA:5TY-8OX <br />COM?LETION COMPLETION <br />Ground surface <br />grout <br />ft. <br />ft. <br />ft. <br />O <br />_ o <br />slatted = <br />aK}an <br />= crew+ Pack <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.sucehd.com <br />