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SAN JUMIN <br />i" L�ixl�t , —COUNTY— <br />, � <br />°SUFoa� Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ! 3 Inspector: 1M.SEErt- <br />Facility Address: 1ZOr� L`/�►"}�`►�S <br />Well Address: <br />W P# Wel I#: <br />Soil Boring#:�� <br />Drilling Company: rtJ <br />Driller Onsite: <br />Consultant: k%Lei k4 ft -t;;vtc <br />Geologist: 1ll)aNn/ <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />CAIVIPI Ir\I(,- <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 />❑ Yes ❑ No <br />❑ Yes ❑No <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:_/ <br />Depth to Water: / O Gu/ <br />Grout Material: NAa� cP <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation WBoring Destruction <br />METHOD USED <br />El Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie XOther: ad <br />Water <br />gallons <br />From: <br />Cement 471b <br />Bas <br />Water <br />allons <br />From: <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />kBags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />15 <br />30 <br />3 <br />10 <br />20 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />17.5 <br />30 <br />35 <br />b <br />7 <br />30 <br />60 <br />6 <br />35 70 <br />7 <br />20 <br />40 <br />8 140 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: — <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes El 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 />—ft. <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 1.411 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 I <br />10/16/2017 <br />F 209 464-0138 1 www.sicehd_com <br />