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SANdUAUUIN <br />Ii! —COUNTY-- <br />Greatness <br />COUNTYGreatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Y/io &11 Inspector: A4 S c&A` <br />Facility Address: 20 <br />Well Address: <br />WP# c)U 3eiso7(? Well#: <br />Soil Boring#: 131 <br />Drilling Company: Vt W <br />Driller Onsite: 510- <br />Consultant: <br />1EConsultant: KkQ I i fRgj r 'f vy- <br />Geologist: A, Ic I <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />cnnnDi Mir- <br />Holding <br />in <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />Verified Chain of Custody: ❑ Yes ❑No <br />conn c <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes 1:1 No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: W <br />Depth to Water: M) C Llj <br />Grout Material: N c j cey0 a ni f <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation QLIBoring Destruction <br />KACTunn I Krrl <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity IRTremie ❑Other: <br />Water <br />gallons <br />Cement 47lb <br />Bas <br />Water <br />gall ons <br />Cement 941b <br />Ba s <br />Thickest ThinnestttBags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />so <br />8 <br />5C .Q dY >Z <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />ft. <br />Blank Feet Screen 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 />Bentonite/Gement 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 />