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SANJUAQUIN <br />—COUNTY <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:ia/zeV_< Inspector: n.4,9st-6" <br />Facility Address: -q7Y'/ /i1u. A 1-4 <br />Well Address: <br />WP# e223%)7/ Well#: <br />Soil Boring#: & <br />Drilling Company: <br />Driller Onsite: Z"ii <br />Consultant: &Oitl felelee _ <br />Geologist: A,tr-1 <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑ No <br />SAMPLING <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Holding Temperature: <br />ttBags <br />Thickest Thinnest <br />Method: <br />1.5 <br />5 <br />Screening Method: <br />5 <br />10 <br />Verified Chain of Custody: <br />❑ Yes <br />El No <br />SPOILS <br />10 <br />20 <br />Contamination Noted: <br />❑ Yes <br />El No <br />If yes, spoils storage Location: <br />15 <br />30 <br />Covered: <br />❑ Yes <br />❑ No <br />If yes, material: <br />20 <br />40 <br />GROUTING or DESTRUCTION Total Depth: 5 <br />Depth to Water: Ab <br />Grout Material: Mu, cef, f <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation )4Boring Destruction <br />METHOD USED <br />❑Pressure Grout []Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />gallons <br />From: <br />Cement 471b <br />Bas <br />Filter Pack <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />NBags <br />1.5 <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 <br />1 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />6�,, o zr,k <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type <br />6 <br />it <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 />casing <br />height <br />ABOVE -GROUND C4-fiASSTY43OX <br />COMPLETION COMPLETION <br />Ground surra c. <br />grout <br />ft. <br />ft. <br />ft. <br />r <br />_ o <br />slotted = c <br />soon <br />pawl pads <br />Ui <br />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 S% 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 />