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SAN 1UAQUIN Environmental Health Department <br />—COUNTY— <br />Monitoring Well/Soil Boring Inspection Report <br />Date: L Zoe Inspector: IIJAS4inA/ <br />Facility Address: y/)l W. �6� 6q1<. -,d, <br />Well Address: d <br />WP#fes 9297/ Well#: <br />Soil Boring#: ,E 2 <br />Drilling Company:Gii4 <br />Driller Onsite: <br />Consultant: Pi/ r' k'Set^- <br />Geologist: CA Id <br />Public Water System Onsite: ❑ Yes kNo <br />Domestic Well Onsite: ❑ Yes kNo <br />If yes, location and distance: <br />CANAPI II\lr. <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody <br />CPnn c <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 />GROUTING or DESTRUCTION Total Depth: Sd <br />Depth to Water: <br />Grout Material: /Ve's C e"4ent <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation >kBoring Destruction <br />METHOD USED <br />Pressure Grout ❑Over Drill <br />❑ Gravity ATremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Baps <br />Water <br />zallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />uBags <br />Thickest Thinnest <br />4Bags <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 1 <br />60 <br />17.5 <br />35 <br />7 <br />35 1 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 1 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth:_ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnmpi FTMN <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />it. <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 />ft - <br />Screen Feet <br />BentonitelCement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />5 yallo <br />1868 E. Hazelton Avenue I Stocktonlifornia 95205 1 T 209 468-3420 1 F 209 464-0138 <br />10/16/2017 <br />I www.sicehd.com <br />