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SAN]OAQUIN <br />---COUNTY-- <br />Greatness <br />-COUNTY--Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: I.3 19 Inspector: QrVIIGWYIIVw— <br />Facility Address: (o -7 0 1 E• s 0 y <br />Well Address: <br />wP# 00 3 `-f 0 '2� Well#: <br />Soil Boring#: 'a <br />Drilling Company: Te ✓ITc�vt. <br />Driller Onsite: F—Col Al2- <br />Consultant: TP.rY%tG0✓ — <br />Geologist: 67a,1ry-e,-i(`C' <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />LIVAI �,u11111101re <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water: N/A <br />Grout Material: I-iylo,&A - ber)+cy1,4e— i t ps <br />Gallons of Grout Used <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation>63oring Destruction <br />AM111d'ri1l7IL14d01 <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />JJ Bags <br />Thickest Thinnest <br />V Bags <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 />is <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 80 <br />8 <br />CONSTRUCTION <br />Total Depth: �^r <br />Drilling Rig Type: CT 5A 6 <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnMPI FTInIU <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 />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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />