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SAN JUAQUIN <br />`•, Environmental Health Department <br />i10"N —COUNTY— <br />Greatness rov;-, Fere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: - ?Wiclk <br />Inspector: A'S66ot- <br />Facility Address: V/C7 <br />AA OVAr)w�z � <br />Well Address: <br />Thickest Thinnest <br />WP# Dd 37:5'2/ <br />Well#: <br />Soil Boring#: 32 <br />2.5 5 <br />Drilling Company: 7r_--'r4Law <br />El No <br />Driller Onsite: <br />1 <br />Consultant: Ale, / <br />)5t <br />Geologist: Gres <br />20 <br />Public Water System Onsite: ❑ Yes DdNo <br />Domestic Well Onsite: ❑ Yes XNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Cement 471b <br />Bas <br />Verified Chain of Custody: ❑ Yes <br />❑ No <br />SPOILS <br />Thickest Thinnest <br />Contamination Noted: ❑ Yes <br />11 No <br />If yes, spoils storage Location: <br />2.5 5 <br />Covered: ❑ Yes <br />El No <br />If yes, material: <br />1 <br />GROUTING or DESTRUCTION Total Depth: <br />)5t <br />Depth to Water: <br />20 <br />Grout Material: <br />7.5 15 <br />Gallons of Grout Used: <br />15 <br />❑Well Installation ❑Well Destruction <br />3 <br />❑Boring Installation 5QBoring Destruction <br />METHOD USED 6o'z �►��"� <br />❑Pressure Grout ❑ Ove r Drill 3 1, _&,+v -.t v - 1 <br />❑ Gravity ❑Tremie i dOther: r_ee I <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />ffallons <br />Filter Pack <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />kBags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 1 <br />70 <br />7 <br />20 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: ❑ Yes El No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑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 />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />d <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 />