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SAN JOAQUIN <br />—COU NTY— <br />• Greohies5 q;ons here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Ib ZZ Inspector: / CONSTRUCTION <br />Facility Address: 5 Vexfr k <br />Well Address: Total Depth: <br />WP# 01A Well#: Drilling Rig Type: <br />Soil Boring#: (0 — <br />Drilling Company: <br />Driller Onsite: <br />Consultant: (,13r\ <br />Geologist:�/� i <br />Public Water System Onsite <br />" Annular EHD Seal Verified <br />0�) MinIn <br />SLength <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes 1:1 No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: <br />If t ' I <br />❑ Yes El No <br />yes, ma erla . <br />GROUTING or DESTRUCTION Total Depth: �..�✓� <br />Depth to Water: .,/I j K <br />Grout Material: 11, 64f P/Y'L,i IVA- <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destructio" <br />❑Boring Installation XBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity_XT re7ue ❑Other: <br />Water <br />gall] s <br />Cement 471� <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ABags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 <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 />❑ Yes El No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />—CWT <br />ABOVE -GROUND CMRtSTY-BOX <br />COMPLETION COMPLETION <br />around surface <br />prom <br />ft. <br />ft. _ <br />,< <br />= a <br />— o <br />&btted :^ <br />&scion tTv <br />11 T_.r,P­k <br />2125, ZS� <br />ft. <br />1 <br />MATERIALS/DEV L5PMENT <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 209 468-34201 F 209 464-0138 1 www.socehd.com <br />