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SAKdOAQUIN <br />Environmental Health Department <br />COUNTY— <br />,,-��,_�,,...• Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 6/2 <br />Inspector: �iCc Vrt i VI — <br />Facility Address: <br />7utC'Kei Vy\avt- PiJ- <br />Well Address: <br />#Bags <br />WP# <br />Well#: <br />Soil Boring#: CPT <br />- 9L <br />Drilling Company: <br />'dde ,�2 <br />Driller Onsite: Pori <br />rolK <br />Consultant: <br />r <br />Geologist: <br />3 <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />CAM PI II\Ir. <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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />in 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />If yes, material: <br />i <br />GROUTING or DESTRUCTION Total Depth: / 00 <br />Depth to Water: <br />Grout Material: + <br />Gallons of Grout Used: <br />❑Well Installation ❑Well -Destruction <br />El Boring Installation>Ooring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />wallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <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 60 . <br />6 <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 />Aa7TC <br />asing <br />height <br />— SCVE-dFICUND <br />COWLI=ION CHH sw-3ox <br />COMPLETION <br />Ground SLx1ace <br />grout <br />ft_ <br />ft. <br />= o <br />s+caon _ <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 j3°!° Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.821 4.71 <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 />