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SAN 1UAUUIN <br />"I•' -COUNTY --- <br />`�1i,Faaa,' Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: o / Ze's, Inspector: /VA&&— <br />Facility Address: 1/0 f/rbacl! 4vyltic <br />Well Address: <br />WP# C":5-do7Z Well#: <br />Soil Boring#: B1 <br />Drilling Company: V4,4.) <br />Driller Onsite: <br />Consultant:1(1v+h re ld e <br />Geologist: 111 541 <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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes []No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: Ivy <br />Depth to Water: &)Z) cam► <br />Grout Material: -e—oi cr�rvW•.L <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation KBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity IXTremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />lZall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />0Bags <br />Thickest Thinnest <br />NBags <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 1 <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 1 <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 />SPP c>T11 <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />n. <br />n. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />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.sicehd.com <br />