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SAN,JOAQUIN <br />Environmental Health Department <br />COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 5/►, 7 /1 Inspector: i V1.2� CONSTRUCTION <br />Facility Address: a2q 5,547 5. Biy—d idol. Trot <br />Well Address: Total Depth: <br />WP# On 3 19 oZ 5 9 Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: � ' 'n - - ,� ��Min 2" Annular EHD Seal Verified <br />Driller Onsite: e� u Screen Length From: <br />Filter Pack From: <br />Consultant: <br />Geologist: Bentonite From: <br />Grout From: <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 />If yes, material: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: 60 <br />Depth to Water: 1 <br />1 <br />Grout Material: /yPQ 1 ry4'� <br />Gallons of Grout Used: SSS <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Woring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �I,Tremie Other: faj I <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />g allons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#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 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />casing <br />height <br />ABOVE -GROUND CtHR STY -Box <br />006PLETION COMPLETION <br />Ground surat <br />grout <br />ft. <br />fl. <br />ft. <br />_ o <br />_ o <br />slotted _ <br />sacyon <br />gravw pack <br />tt.2Fh. <br />MATERIALS/DEVELOPMENT <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 />�J$ 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 />