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SAN,JOAQUIN <br />—COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />Monitorin Well/Soil Boring Inspection Repor <br />Date: Inspector: CONSTRUCTION <br />Facility Address: �l`l�. K- <br />Well Address: 5Ajnn 4\-, Total Depth: <br />WP# I -A Z. 227 Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: C �iln`T Min 2" Annular EHD Seal Verified: <br />Driller Onsite: itJ 6Screen Length From: <br />Filter Pack From: <br />Consultant: <br />Geologist: 4 -5P5 ,-fL,i t�T aA, t / f5 Bentonite From: <br />Grout From: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />dyes El No <br />OYes ❑No <br />SAMPLING <br />'Nater <br />eall ons <br />Holding Temperature: <br />Cement 941b <br />Bags <br />Method: <br />#Bags <br />Screening Method: <br />#Bags <br />Verified Chain of Custody: <br />❑ Yes ❑No <br />SPOILS <br />s <br />Contamination Noted: A; 4V G 3?i Yes ❑No <br />If yes, spoils storage Location: <br />5 <br />Covered: <br />❑ Yes ❑ No <br />If yes, material: <br />20 <br />GROUTING or DESTRUCTION Total Depth: 5 �� <br />Depth to Water: 30 - �5 <br />Grout Material: n/ 'L� L <br />Gallons of Grout Used: ao� <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Cf ]Boring Destruction <br />I%AFTWnn I ICFs <br />El Pressure Grout ❑Over Drill <br />❑ Gravity [ Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />'Nater <br />eall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />1 <br />s <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />AWVE-GROUND cMmay-sox <br />COMPLETION COMPLETION <br />Ground Surface <br />QroLn <br />tt. <br />ft. _ <br />� = o <br />-- o <br />stonad = E <br />sac5on — <br />9r" pack <br />Ni <br />_— <br />ft, = 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.socehd.com <br />