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SAK JOAQUIN <br />Greatness grows here <br />Monitoring Well/Soi <br />Date: Inspector:47t <br />Facility Address: <br />Well Address: 1071 /Y i <br />WP# (20 3 A6'"dys Well#: _7��C_r <br />Soil Boring#: ; ,'l 3 <br />Drilling Company: a� / <br />Driller Onsite: MI& /A C61 �y <br />Consultant: rrur -►G <br />Geologist: / �y <br />Public Water System Onsite: ❑ Yes 11 No <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 <br />SPOILS <br />Contamination Noted <br />If yes, spoils storage Location: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />Covered: ❑ Yes 11 No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: Ize <br />Depth to Water: . /0 r <br />Grout Material: �(//1�r12rtT <br />Gallons of Grout Used: 9, <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Aforing Destruction <br />METHOD USED Z, a <br />❑Pressure Grout ❑Over Drill /"'( <br />❑ Gravity �fremie ❑Other: rrff <br />Water <br />gall s <br />Ceme 47. <br />a s <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Wags <br />Thickest Thinnest <br />uBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />Environmental Health Department <br />Boring Inspection Report <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND C-SLS7Y43OX <br />COMPLETION COMPLETION <br />Grund surra. <br />Ori <br />n. <br />n. <br />fi. <br />v� O <br />_ <br />_ o <br />slortnd <br />s*con <br />ssnw+ � <br />n. 21 4 E IFtt. <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 3% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />lZ' ;'q_ J �r le, ( iP Ph-� 10/16/2017 <br />i <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />