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SANAUANIN <br />Environmental Health Department <br />—COUNTY— <br />=. Greatness grows here. <br />© Monitorin�gy�Well/Soil Boring Inspection Report <br />Date: Zl O Inspector: ��t 1 V CONSTRUCTION <br />Facility Address: <br />Well Address: W . YOSeWV SSW N <br />WP# 0 D 3c5XWell#: <br />Soil Boring#: R—ll <br />Drilling Company: C 11 <br />— <br />Driller Onsite: 1ien <br />Consultant: TO W <br />Geologist: <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />cpnll q <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From <br />Filter Pack <br />From <br />Bentonite <br />From <br />Grout <br />From <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: — <br />Grout Material: cemQii f <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation 43oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Irkrerri ,A ElOther: <br />Water <br />allons <br />Cement 471b <br />Baas <br />Water <br />vall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />kBags <br />Thickest Thinnest <br />4Bags <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 />30 616 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />� <br />� �height , <br />Y <br />ABC-AGRCLTND Ct%ifSTl BOX <br />CO&FL=—MN cot iPLE rioN <br />Ground sumacs <br />procrt <br />tt_ <br />tt. <br />_ O <br />slottad <br />Bacon } <br />1 �,t' _ .: gi-viW pack <br />it. <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 />Benton itefCement 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 />1368 E. Hazelton Avenue j Stockton, California 95205 � 7 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />