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SAN 10AQUIN <br />COUNTY <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: '�� Inspector: CONSTRUCTION <br />Facility Address:—. 'r ta— <br />Well Arirlr^-- __1 J Total Depth: <br />WP#----, t" N Well#: Drilling Rig Type: <br />Soil Boring#: - YI- <br />Drilling Company: U'V- `�c Min 2" Annular EHD Seal Verified: <br />Driller Onsite: 1PA � , � D, N" I Screen Length From: To <br />❑ Yes ❑ No <br />Consultant: c, o,,, Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Public Water System Onsite: ❑ Yes FINo <br />Domestic Well Onsite: ❑ Yes 2'No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />cpn11 r, <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Tota Depth: <br />Depth to Water: <br />Grout Material: Vj <br />Gallons of Grout Used: !sA"kms[ 5 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installatior4Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity &remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />t+Bags <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 />4 <br />20 <br />40 <br />4 <br />12.5 1 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 5 <br />35 <br />70 <br />7 <br />20 40 <br />40 <br />80 <br />8 <br />u <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <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.socehd.com <br />