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v yoga` SAN.PIOAQUIN <br />Environmental Health Department <br />—COUNTY— <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ZZ Inspector: L <br />Facility Address: 56'5 <br />Well Address: <br />WP# Well#: <br />Soil Boring#:\_ T— <br />Drilling Company: P0t1in1 Leh C-"J&Q dry <br />Driller Onsite: l/ <br />Consultant: <br />Geologist: <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />rMin,.2" Annular EHD Seal Verified <br />Sc�eehl gth From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />3►A\�1J001Me <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 ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:' 1 �5 5�15�t5 <br />Depth to Water: Ski <br />Grout Material: OPn <br />Gallons of Grout Used: 'jtya�l <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />MFTHnn I ICFn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑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 />uBags <br />Thickest Thinnest <br />t18a <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 />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRZTY43OX <br />COMPLETION COMPLETION <br />Ground Su facs If <br />protA <br />ft. <br />tt. <br />ft. <br />_ . <br />— o <br />sIcnad <br />soon <br />�'; = gnval pack <br />tt =IFn. <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 />'i"'(Z 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 />5�5 <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 />