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r <br />..1 <br />SAN J0AQUIN <br />COUNTY <br />Environmental Health Department <br />Esc; opr"' Greatness grows i,erc. <br />1 2141( k Monitoring Well/Soil Boring Inspection Report <br />Date: WInspector: 4 _A CONSTRUCTION <br />Facility Add ess: r .�/ -I , <br />Well Address: 1' 1ctV"' Total Depth: <br />WP# Well#: ) Drilling Rig Type: <br />Soil Boring#: Q Min 2" Annular EHD Seal Verified: <br />Drilling Company: Wd , <br />❑ Yes El No <br />Driller Onsite: 'wr <br />Cement 471b <br />Bas <br />Water <br />Rallons <br />Screen Length <br />From: <br />To: <br />Consultant: <br />tlBags <br />Z.5 5 <br />Filter Pack <br />From: <br />To: <br />Geologist: <br />2 <br />GJ <br />Bentonite <br />From: <br />To: <br />15 30 <br />3 <br />10 20 <br />Grout <br />From: <br />To: <br />12,5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />Public Water System Onslte: <br />❑ Yes <br />No <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite: <br />❑ Yes <br />No <br />casing <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custo <br />SPOILS <br />Contamination Xoted <br />If/re <br />s storage Location: <br />CovIfrial: <br />❑ Yes ❑No <br />❑ Yes EJ No <br />❑ Yes El No <br />GROUTING or DESTRUCTION Total Depth:r� <br />Depth to Water: ' <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑We#T estructI 9 �� <br />El Boring Installation,oring Destruction <br />METHOD USED G v &-7) <br />V4 <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity\4Tremie � Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Rallons <br />Cerh ent 94 lb <br />Bags <br />Thickest Thinnest <br />k Bas <br />Thickest Thinnest <br />tlBags <br />Z.5 5 <br />5 10 <br />1 <br />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 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />T height <br />ABOVE-GRCYJND ci iA1STY sox <br />COkSPLETiON C WPLE'noN <br />c3cocind sut�c..-.� <br />grout <br />n. <br />a <br />slotted < -= <br />sat;ion g <br />_ vs,lt pack <br />:B — <br />n = n. <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 />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />