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)�POa6• C� <br />_ SAN:_JOAQUIN <br />.,. Environmental Health Department <br />-� —COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: Yoke WoYy-Ieo CONSTRUCTION <br />Facility Address: U PaVnP b '?amvr61 <br />Well Address::2�, d . Total Depth: <br />WP# 00 J IQ 0-1 Well#: Drilling Rig Type: <br />Soil Boring#: - Min 2" Annular EHD Seal Verified <br />❑ Yes ❑No <br />Drilling Company: 1 S'r1L <br />El No <br />If yes, location and distance: <br />Cement 94 lb <br />Bags <br />Driller Onsite: <br />Screen Length <br />From: <br />To: <br />Consultant: <br />Filter Pack <br />From: <br />To: <br />Geologist: <br />Bentonite <br />From: <br />To: <br />Contamination Noted: ❑ Yes <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes Pj& <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite: ❑ Yes <br />El No <br />If yes, location and distance: <br />Cement 94 lb <br />Bags <br />SAMPLING <br />ttBags <br />Holding Temperature: <br />Bags <br />Method: <br />1 <br />Screening Method: <br />1 <br />Verified Chain of Custody: ❑ Yes <br />El No <br />SPOILS <br />2 <br />Contamination Noted: ❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />3 <br />Covered: ❑ Yes <br />L1 No <br />If yes, material: <br />4 <br />R0UTIN r Total Depth: <br />5 <br />if <br />gep to Water: ry <br />5 <br />(� Grout Material: l l7.3 SGtGK <br />6 <br />Gallons of Grout Used: <br />6 <br />J� <br />❑Well Installation ❑Well Destruction <br />7 <br />❑Boring Installation VBoriinn&Destr ction <br />-t" Port <br />' cd <br />METHOD USED 1 <br />q f bctj(* <br />20 40 <br />❑Pressure Grout ❑Over Drill <br />40 1 80 <br />❑ Gravity ❑Tremie ®Other: _ Ice �RI <br />Water <br />gallons <br />Cement 47lb <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <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 30 <br />6 <br />1 30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 1 80 <br />8 <br />casing <br />height <br />ABOVE -GROUND CHRM'TY43OX <br />CONFLETlON COMPLETION <br />Ground surface <br />grout <br />ft. <br />tt. <br />ft. _ <br />0 <br />— o <br />s2ed c <br />on — B <br />g-�g P-X <br />tt. = tt. <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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />