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SANiJOAQUIN <br />� Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Dater 30 1 �26 � Inspector: (36a,6 l <br />Facility Adclreqs:1?jq�o mnigE gnpee4- <br />Drilling <br />D• <br />Geologist: RM I N 0 - <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding perature: <br />Met d: <br />S Bening Method: <br />Verified Chain of Custody: <br />SPOILS <br />C/ered: <br />n Noted: <br />s storage Location: <br />C <br />❑ Yes ❑No <br />❑ Yes 11 No <br />❑ Yes ❑No <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 />❑ Yes ❑No <br />From: To: <br />From: To: <br />From: To: <br />From <br />❑ Stove Pipe <br />casing <br />height <br />ABOVE -GROUND G} RL -1 Y -30X <br />COWPL=--TION COMP EMON <br />cr«;r-a suiaca <br />grout <br />n. <br />tt. <br />slottQd '"_ - <br />7XV81;ack <br />If yes, material: :" <br />GROUTING oi-ESTRUCTION Total Depth: I- �( ''• <br />Depth to Water: _ "14 Wa ' <br />Grout Material: NGAt C Nt%,J �2- (.()Ff <br />Gallons of Grout Used: (no IALS DEVELOPMENT <br />1�. <br />❑Christie Box <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationABoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />sing ype: <br />IB3_da.f+_ Blank Feet Screen Feet <br />(tiff g,�•��„��� <br />Bags of Cement: <br />b r,., Bags Sand/Gravel: <br />p �`�• ,�Ty�pe//'Brand Bentonite: <br />Clio l� V4N /Size: <br />❑ Gravity >�Tr m ❑Othe : � iType of Method: <br />D1 091� <br />Water <br />Rations <br />Cement Ib <br />Baas <br />I k 1water <br />Rations <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 1 <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 1 30 <br />6 <br />30 60 1 <br />6 <br />17.5 1 35 <br />7 <br />35 70 1 <br />7 <br />20 1 40 <br />8 <br />40 80 1 <br />8 <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 lb 2.62 4.7 <br />' lull •O + 10/16/2017 <br />1368E. Hazelton Avenue j Stockton, Cailfornia 95205 1 7 209468-3420 1 F 209464-13138 1 www.sicehd.com <br />