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S A N ��10 A Q U I N <br />�- Environmental Health Department <br />—COUNTY <br />G-eutness grows Fere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date. 18 Inspector: <br />Facility Addre'ss: Z3, <br />Well Address: <br />WP# Well#: <br />Soil Boring#: - t) <br />Drilling Compan :4�n-ex <br />Driller Onsite: AAe e_ <br />Consultant:YLo�- <br />Geologist:-�il.E� <br />Public Water System Onsite: ❑ Yes $Vo <br />Domestic Well Onsite: ❑ Yes iNo <br />If yes, location and distance: <br />SAMP\Chain <br />Holdinre: <br />Metho <br />Screen <br />Verifiestodv: ❑ Yes El No <br />SPOILS <br />Contaminatio oted: ❑ Yes ❑No <br />If yes oils storage Location: <br />C red: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth'_ <br />Depth to Water: -to <br />Grout Material: <br />Gallons of Grout Used: 0 - <br />❑Well Installation ❑],Well Destruction <br />El Boring Installation IayBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />�ravity �Tremie ❑Other: <br />Water <br />gallons <br />From: <br />Cement 471b <br />Bas <br />Filter Pack <br />Water <br />RaIll ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />tlBags <br />2.5 <br />5 <br />ti <br />5 <br />10 <br />1 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />153 <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 />1 80 <br />8 <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes 0 N <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: ` <br />Grout <br />From: <br />To: <br />ti <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height , <br />ASOVE-GROUND c#imsw-Box <br />CONFL.E ION COMPLETio_ N <br />Gcmina Sur(acs <br />grout <br />t - ft. <br />ft. <br />_ o <br />sbttnd �:.. <br />_ 9 -VW Pack <br />K <br />I IF <br />ft = _ ft <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 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 />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />