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SAN IUAQUIN <br />—COUNTY ---- <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: y&)/ k'iY Inspector: A 6t-60 <br />Facility Address: 2-091) dJd ,02 <br />Well Address: <br />WP# 6o 5 2f67o Well#: <br />Soil Boring#: &z <br />Drilling Company: 114 t,J <br />Driller Onsite: A6 <br />Consultant: Pic Pf �c•� <br />Geologist:uu' <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 />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes 11 No <br />If yes, location and distance: <br />CAKADI <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes 11 No <br />conic c <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: 5 <br />Depth to Water: Wx cmc U <br />Grout Material: Nee ct.,7*�-,. t <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation WBoring Destruction <br />nn CTUfIrl I MrrI <br />El Pressure Grout ❑Over Drill <br />❑ Gravity WTremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />ruBags <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 />80 <br />8 <br />5"2ti' dy <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />tt. <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/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 />