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SAN _JUAUUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />C Monitoring Well/Soil Boring Inspection Report <br />Date: X Inspector: CONSTRUCTION <br />Facility Address: -Lob fW1N`P <br />Well Address: 13 �(�skrc,�GuC Total Depth: <br />WP# © b3 Well'k Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: � o Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Driller Onsite: Lt Screen Length From: To: <br />Consultant: (`r7 -y\ 0 Filter Pack From: To: <br />Geologist: Noy r C SI Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <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 />If yes, material: <br />❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth:--[Lh <br />Depth to Water: b <br />Grout Material:. <br />Gallons of Grout Used: z— <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation �]Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity 17Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br />»Bags <br />Thickest Thinnest <br />#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 />15 <br />30 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />40 80 <br />8 <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 />tt. <br />Screen Feet <br />BentoniteJCement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94Jb 2.82 4.7 <br />\Z-0 '�&v f4z 0 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 <br />10/16/2017 <br />F 209 464-0138 1 www.sicehd.com <br />