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SAN JUAUUIN Environmental Health Department <br />---COUNTY---- <br />Monitoring Well/Soil Boring Inspection Report <br />Date: is I V Inspector: N+4s 6,C <br />Facility Address: 7// s' De A -2-g- /31✓ <br />Well Address: <br />WP# co bS/a6 Well#: <br />Soil Boring#: _93, 13 <br />Drilling Company: 4 W <br />Driller Onsite: A -i <br />Consultant: ev/!c"& /4&v C ji ,/--4 rwJ" <br />Geologist: /2a ✓r Z <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />cANAPI INC. <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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type.'� ikDl(c�J SkN^ 1�9�0'� <br />Min 2" Annular EHD Seal Verified <br />Screen Length From <br />Filter Pack From <br />Bentonite From <br />Grout From <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 11k) G&AJ <br />Grout Material:ue"'fi u^^�✓� <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation XBBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie 12432ther: e- Ad <br />Water <br />gal lons <br />Cement 471b <br />Bas <br />Water <br />eall ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />>YBags <br />Thickest Thinnest <br />NBags <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 />❑ Yes El No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND c4iR1 TY -80x <br />COMPLETION COMPLETICN <br />Ground surface <br />grout <br />it. <br />ft. <br />it. <br />C <br />O <br />elo"d <br />seczon '— <br />n, = tt. <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 lb 2.82 4.7 <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 />