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SANJOAQUIN f <br />' -i _ Environmental Health Department <br />to " COUNTY— <br />=roPa' Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ' Inspector: -Z. liar- to <br />Facility Address: <br />T— <br />Well Address: <br />WP# Well#: <br />Soil Boring#: RC 1$ .• 001 <br />Drilling Company: Cat VrC*\ <br />Driller Onsite: Loc-cy wk1(5Zh <br />Consultant: 14(4 ; n-�-EId& 'r <br />Geologist: V ,' c - v% o, 'yyN OCA -d- , &cc; c <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 1XIo <br />❑ Yes )4 -No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />I <br />GROUTING or DESTRUCTION Total Depth: j 11h2 <br />Depth to Water:_ 3y I <br />Grout Material: Neck EZw'4.wk- <br />Gallons of Grout Used: 11 b <br />❑Well Installation ❑Well Destruction <br />El Boring Installation *Boring Destruction <br />METHOD USED <br />Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />gall ns <br />From: <br />Cement 471b <br />Baas <br />Filter Pack <br />water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#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 />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 />CONSTRUCTION <br />Total Depth:_ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />it. <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 50a Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 <br />10/16/2017 <br />www.sicehd.com <br />