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SAN_JOAQUIN <br />Environmental Health Department <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ^3 Inspector: , IN <br />Facility Address: QU I�_ �1 <br />Well Address: <br />WP# co 3 X 4c) 9 Well#: <br />Soil Boring#: 9 Z <br />' ' 1 <br />Drilling Company: q__ W <br />Driller Onsite: Ir—fr w•� <br />Consultant: Y, 10 jv` i — <br />Geologist: <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />&FT0u10 <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: ov 10 <br />Grout Material: QA C <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Coring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Aremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Baas <br />Water <br />wallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />r; Bags <br />Thickest Thinnest <br />4Bags <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 />50 <br />5 <br />15 <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 />s <br />40 so <br />s <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />e. C. <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />1WT <br />Asnv�-�aouNfl c�t>s-rr-aox - <br />CO&FLETION COMPLETION <br />cro;nd Sinal. <br />grout <br />it. <br />ft. <br />ft. <br />_= o <br />— o <br />slotted '-° <br />saC,on <br />g-,rN pack <br />tt.IFft! I, IFn. <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 />N flies. CA; wv- s tD� *.IN � rural s M& 5ik <br />^j U'A J Zp K�ld Il,�'5 M;n 10/16/2017 <br />1368 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />