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�'. SAN-JOAQUIN <br />Environmental Health Department <br />—COUNTY— <br />, <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ovio <br />Inspector: )-�e vt,I &M %V\ <br />Facility Address: a1 <br />a. I tJ . ZL4CKk,,-&k ivL Rd. <br />Well Address: <br />Cement 941b <br />Baas <br />WP# Oo Agy -7-3 <br />Well#: <br />Soil Boring#: CF" -r <br />—) <br />Drilling Company: Micidje. <br />5 <br />Driller Onsite: RyK <br />vy e_ E2 rod' a <br />Consultant: ,-5aqq <br />EVIA I►'lp l�✓)a <br />E <br />Geologist: VQ.Y"- <br />10 <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 />SPOILS <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ONO <br />❑ Yes ONO <br />❑ Yes ❑No <br />i <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: C1 <br />Grout Material: V1,Q6L C?AnYIA41' <br />Gallons of Grout Used: / S; <br />❑Well Installation ❑Well, Destruction <br />❑Boring Installation 913oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �<Tremie ❑Other: <br />Water <br />allons <br />.Ment 471 <br />Lags <br />Water <br />allons <br />Cement 941b <br />Baas <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 />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 <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />casing <br />height <br />ABOVE -GROUND CHIRMT r -Bax <br />coli Lmioa coMPtETioN <br />GroUna SWaca <br />grout <br />tt_ <br />n. <br />ft. <br />2 <br />. <br />sec,cn — A <br />— 9 -VW pacts <br />Y i <br />ft. <br />MATERIALS/DEVELOPMENT <br />❑ Yes El No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 lb 2.82 4.7 <br />10/16/2017 <br />1368 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 4640138 1 mvw.sicehd.com <br />