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2 <br />SAN:JUAQUIN <br />i <br />—COUNTY— <br />`c'��.rFoar>>¢,� Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: yh-hy Inspector: <br />Facility Address: /// s• .v e_ g/ld <br />Well Address: <br />WP# 62!:� 3g/dd Well#: <br />Soil Boring#: ,[--- <br />Drilling Company: ;1,4 t,J <br />Driller Onsite: .4 /e <br />Consultant: btlg tA,c e_ &kvl Aso e t <br />Geologist: RQ „ar( <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />CAKADI lKir- <br />Holding Temperature: <br />Method: <br />Screening Method: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: �Y� 1-i�ll,c�u�1 5�ew w�Qr <br />Min 2" Annular EHD Seal Verified: ❑ Yes E] No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes El No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: Zdt <br />Depth to Water: /8f <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation XBoring Destruction <br />RACTUnn 1 ICCs <br />IXPressure Grout ❑Over Drill <br />❑ Gravity I RTremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />NBags <br />Thickest Thinnest <br />ttBags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 1 80 <br />s <br />casing <br />37 height —EWT <br />ABOVE -GROUND CHF11STY430X <br />COMPLETION coMPLEncN <br />Ground surface <br />grout <br />it. <br />n. <br />ft. <br />0 <br />abttad = Z <br />sec�on — <br />g -w P-* <br />JI <br />n. = n. <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 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />