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L <br />v SAN>JOAQUIN <br />COUNTY <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: J Inspector: w n't <br />Facility Address: �i Z u r <br />Well Address: <br />W P# Well#- <br />Soil Boring#: _ �— <br />Drilling Company: --�c' r <br />Driller Onsite: u b <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />CONSTRUCTION l <br />�2 <br />Total Depth: <br />Drilling Rig Type <br />/No <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />Min 2" Annular EHD Seal Verified: <br />❑ Yes <br />#Bags <br />Screen Length From: <br />To: <br />�,po <br />Filter Pack From: <br />To: <br />1 <br />Bentonite From: <br />To: <br />r I� <br />Grout From: <br />To: <br />2 <br />COMPLETION ❑ Stove Pipe <br />❑Christie Box <br />J <br />--ii---- casing <br />♦ height <br />30 <br />J <br />10 <br />20 <br />4 <br />SAMPLING ABOVE -GROUND <br />Holding Temperature: COMPLETION coMpl=10N <br />Method: arwnd Surface <br />Screening Method: A}arm <br />Verified Chain of Custody: <br />El ❑No C( �� Q `�` �h' <br />ft. <br />canllc ��ir ft. <br />Contamination Noted: ❑ Yes []No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />— m <br />CZ <br />_ o <br />s to ttae <br />aec+cn <br />s -v+ P ---:k <br />GROUTING or DESTRUCTION Totil�epth: <br />Depth to Water: ft ft' <br />Grout Material: vtti91-1 <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 ?4remie ❑Other: <br />Water <br />gall s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2,5 <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 />60 <br />6 <br />17.5 <br />35 <br />35 <br />70 <br />7 <br />20 <br />40 <br />40 <br />80 <br />8 <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 />; V, 41-'e <br />r►� d S'� M r <br />ISI . �-C 4 <br />ruJ; G�'\ I -V -945-t 6""' 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 />