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SAN JOAQUIN <br />---COUNTY <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: -1-AA-(-X.)- Inspector: t r-G-1r'� CONSTRUCTION <br />Facility Address: <br />Well Address: Total Depth: <br />WP# A 3 1- Well#: Drilling Rig Type: LM,4 <br />Soil Boring#: <br />Drilling Company: � Min 2" Annular EHD Seal Verified: El Yes []No <br />Driller Onsite: Lu- Screen Length From: To: <br />Consultant: ��+�s6n ►� Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />CAKAPI II\I(; <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 />If yes, material: <br />❑ Yes EI—No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: V'� <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation,2 rBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 21'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 />9 Bags <br />Thickest Thinnest <br />a Bags <br />2.s 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 />25 50 <br />5 <br />15 30 <br />30 1 60 <br />6 <br />Y . 35 <br />35 1 70 <br />7 <br />40 <br />40 1 80 <br />8 <br />casing <br />height <br />ABOVE -GROUND C7iASTY43OX <br />CO&FLETION COMPLETION <br />Ground Surface <br />grout <br />ft. <br />= r <br />stoned = 4 <br />section — .8 <br />gnvd Pack <br />n. kff" n. <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 lb 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.secehd.com <br />