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;,uP�llh <br />SAN JOAQUIN Environmental Health Department <br />---COUNTY <br />`9erop `' Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: k CONSTRUCTION <br />Facility Address: 01'413 Lv,,-* Lc4,wL <br />Well Address: Total Depth: <br />WP# oA 38l Well#: Drilling Rig Type: <br />Soil Boring#: (-V7 , (-`i5� �- i'i� CSS, 4- <br />Min 2 Annular EHD Seal Verified: El Yes ❑No <br />Drilling Company: �- ivQS� ��`ib <br />Driller Onsite: Screen Length From: To: <br />Consultant: :2't L!i Filter Pack From: To: <br />Geologist: �, ri Li WVA Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <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 ElNNo <br />❑ Yes 'L_INo <br />❑ Yes ❑No <br />❑ Yes "k,"'0 <br />❑ Yes ❑ No <br />If yes, material: / <br />GROUTING or DESTRUCTION Total Depth:��, b <br />Depth to Water: 0 v 01 <br />Grout Material: <br />Gallons of Grout Used: ^- <br />❑Well Installation ❑Well Destruction <br />El Boring Installation 1X0 <br />0ring Destruction <br />METHOD USED 111 <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />tt Bags <br />Thickest Thinnest <br />b Bags <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 />311, <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 />tt. <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.secehd.com <br />