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z SAN,1UAUUIN <br />LLLIit ---COUNTY <br />R.A. <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Y/;- 0 /.V- Inspector: AlOCZ-6.,L_ <br />Facility Address: <br />Well Address: 12-71 "/4!/ti <br />WP# Well#: <br />Soil Boring#: c,,6 7e 7 <br />Drilling Company: t r -"e <br />Driller Onsite: <br />Consultant: _ea.A~6 -a <br />Geologist: %id Cee%te-'''a/tC <br />Public Water System Onsite: ❑ Yes ❑ 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: ❑ Yes El No <br />Cpr)ll C <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: Z3 <br />Depth to Water: // ' <br />Grout Material: AAe-�<e,..� <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />MFTWnn I ICFn <br />El Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br />4Bags <br />Bentonite <br />#Bags <br />2.5 5 <br />Grout <br />10 <br />1 <br />5 10 <br />2 <br />EThickestThinnest <br />20 <br />2 <br />7.5 15 <br />3 <br />30 <br />3 <br />10 20 <br />4 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 SO <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 8o <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 />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 -1 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 />