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u SAN JOAQUIN <br />Environmental Health Department <br />—COUNTY— <br />Ss<�,,R' Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: CONSTRUCTION <br />Facility Address: �C <br />Well Address: Total Depth: JCS <br />WP# L90 Well#: Drilling Rig Type: �-t'+� " NVQ 2D� <br />SoilBoring#: JR Cf <br />Drilling Company:y'�— VJ Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Driller Onsite: � t—.;n, � Screen Length From: To: <br />Consultant: IC-�e P �p�o r Filter Pack From: To: <br />Geologist: M ��"` Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <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 ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes El No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: —11 <br />Grout Material: C 4.A 0,1 ed: <br />Gallons of Grout Used: 70 <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Boring Destruction <br />ILVA Sid! r17171Mill 11 <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 'Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Baas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />kBags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 <br />30 60 <br />6 <br />17.5 1 35 <br />7 <br />35 70 <br />7 <br />20 1 <br />80 <br />8 <br />casing <br />height <br />ABOVE-GIRCUND Ci-i157Y-50X <br />COWLEr1ON COWLE770N <br />Ground surra. <br />grout <br />fi. <br />ft. } <br />w <br />_ o <br />0 <br />stormed = M <br />Pack <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 />10/16/2017 <br />1888 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />