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SAN,-JOAQUIN Environmental Health Department <br />; <br />—COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 21-Z1 I I V Inspector: A1,45e4- '14 <br />Facility Address: 671--R*f f <br />Well Address: <br />WP# GYM 37974 Well#: <br />Soil Boring#: R 2. <br />Drilling Company: <br />Driller Onsite: 0a -K —laKGd <br />Consultant: %a�t� .9arou S <br />Geologist: _A?tW <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />CAIVIPI Ihlr <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: ❑ Yes El No <br />r,Pnn c <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 3S` <br />Depth to Water: V <br />Grout Material: pjoa. f [ ew -e- + <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation (Boring Destruction <br />METHOD USED <br />Pressure Grout ❑Over Drill <br />❑ Gravity Xrremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />t Bags <br />Thickest Thinnest <br />is 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 />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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHR*'TY-30X <br />COM?LEr10N COMPLETION <br />crouod sutx* <br />grout <br />ft. <br />ft. <br />tt. <br />= o <br />-= o <br />slattad vt ;- - � <br />s+c�on = 3 <br />grav>a rack <br />3 <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 4.7 <br />3z but'S (4716S) Mn ;(4 t`� 75 jcigoK Wu, 10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />