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SAN JOAQUIN <br />LL- i2 "; _COUNTY --- <br />°q Greotness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: S z, J 1 Inspector: MA Facility Address: tj ctu( N •D�rc1cw W,a <br />Well Address: <br />WP# t903. 2-gq Well#: <br />Soil Boring#: Q 2- 3, <br />Drilling Company: M1,d e <br />Driller Onsite:few-0 o <br />consultant:ytaC- <br />Geologist: /i3c., w <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes <br />If yes, location and distance: <br />❑No <br />SAMPLING <br />Water <br />gallons <br />Holding Temperature: <br />Cement 941b <br />Bags <br />Method: <br />#Bags <br />Screening Method: <br />aBags <br />Verified Chain of Custody: ❑ Yes <br />El No <br />SPOILS <br />5 <br />Contamination Noted: ❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />10 <br />Covered: ❑ Yes <br />❑ No <br />If yes, material: <br />2 <br />GROUTING or DESTRUCTION Total Depth: 5y <br />Depth to Water: Q t <br />3 <br />Grout Material: AX -cc. <br />30 <br />Gallons of Grout Used: <br />10 <br />❑Well Installation ❑Well Destruction <br />4 <br />❑Boring Installation KBoring Destruction <br />METHOD USED <br />[kPressure Grout []Over Drill <br />❑ Gravity Xjremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />aBags <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 />109 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite <br />Grout <br />rnkApi FTlnlU <br />From: <br />From: <br />❑ Stove Pipe <br />To: <br />To: <br />❑Christie Box <br />---rrr--- casing <br />height <br />ABOVE -GROUND cr+alST 4M <br />CONFLETlON COMPLETION <br />Gra,rd Surface <br />grout <br />tt. <br />tt. <br />tt. <br />— m <br />_ e <br />— a <br />slotted <br />on — B <br />_ = prow+ past <br />tt. =IFtt. <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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />