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jQ <br />SAN JUAUUIN <br />" +!fk_r COUNTY— <br />' <br />qk, oQa.- Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:tf1/fl Inspector: /9ir4V1_F4 <br />Facility Address: <br />Well Address:7�af, <br />WP# C?9 ,3iIO.V o Well#: <br />Soil Boring#: Bz 3 163 - <br />Drilling Company: ✓e <br />Driller Onsite: 26�as- , <br />Consultant: <br />Geologist: jLlsy %� <br />CONSTRUCTION <br />Total Depth: ,i ,A� SAS— <br />Min <br />� <br />Drilling Rig Type: e; �%9 �- /'JyA /ff� <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 />Public Water System Onsite: ❑ Yes EJ No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑ No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑ No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes E] No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: is <br />Depth to Water: /W) / eP <br />Grout Material: Ale44 <br />Gallons of Grout Used: <br />[]Well Installation ❑Well Destruction <br />❑Boring Installation XBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie 40ther:AW <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />eall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br /># Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />ft. <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 1 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 />