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SAN JOAQUIN <br />couNTv— Environmental Health Department <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: hS Inspector: IGU'Y► ivy - <br />Facility ddress:_ '3q OO k10 1114 by-. Lt2cl <br />Well Address: <br />WP# 0()'3S Well#: <br />Soil Boring#: <br />Drilling Company: e-44 <br />Driller Onsite: CVC4(-V 1V1aA' 1 J <br />Consultant: 3744C.01r-3S <br />Geologist: <br />CONSTRUCTION <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 />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: ❑ Yes []No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: r <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: (� <br />❑Well Installation ❑Well, Destruction <br />❑Boring Instal lation*oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity )4Tremie ❑Other: <br />Water <br />Mons <br />Cement 471b <br />Bates <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />►i Bags <br />Thickest Thinnest <br />ti Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 1 <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 />s <br />25 50 <br />s <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 />casing <br />height <br />ABOVE-dAOUND <br />cot.,PL ET10(V CHPJSiY-Box <br />COMPLETION <br />Craina SWacs <br />Qf17CIi <br />JM <br />tt. <br />w <br />.o <br />$4c$on <br />gmwvi Pack <br />ft. tt. <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 />t-Bentonite <br />ntonite/Cement Mix 3% Mix 3% Mix <br />ntonite per 47 lb 1.41 2.47 <br />per 941b 2.82 4.7 <br />PC bN S 10/16/2017 <br />1388 E. Hazelton Avenue I Stockton, California 95205 1 T 209 46&34201 F 209 4640138 1 v►naw.sicehd.com <br />