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SAN JUAQUIN <br />—COUNTY— <br />a�?' Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Zdli Inspector: <br />Facility ddress: 20157o 6 - <br />Well <br />`Well Address: <br />WP# C1U Well#: <br />Soil Boring#: {el <br />Drilling Company: jzq; -1 <br />Driller Onsite: <br />Consultant:j{14 fpi of ;-,wGeologist: �4- G <br />Public Water System Onsite: ❑ Yes <br />Domestic Well Onsite: ❑ Yes <br />If yes, location and distance: <br />El No <br />❑No <br />SAMPLING <br />Cement 941b <br />Ba s <br />Holding Temperature: <br />>tBags <br />Method: <br />#Bags <br />Screening Method: <br />1 <br />Verified Chain of Custody: ❑ Yes <br />El No <br />SPOILS <br />2 <br />Contamination Noted: ❑ Yes <br />EJ No <br />If yes, spoils storage Location: <br />3 <br />Covered: ❑ Yes <br />El No <br />If yes, material: <br />4 <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />12.5 25 <br />Grout Material: <br />25 50 <br />Gallons of Grout Used: <br />15 30 <br />❑Well Installation ❑Well Destruction <br />30 60 <br />❑Boring Installation WBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity kremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />eallons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br />>tBags <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 />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 />sr- 6L)� <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 />ff1MPl FTInKl <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 />casing <br />height <br />ABOVE -GROUND C 4RiSTY43OX <br />COMPLETION COMPLETION <br />Ground surface T <br />grout <br />ft. <br />ft. <br />ft. <br />= o <br />— o <br />slotted <br />secdon <br />M = gravel pads <br />tt. <br />MATERIALS/DEVELOPM ENT <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 />