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SAN JOAQUIN <br />—COUNTY— <br />Greatness grows here <br />Environmental Health Department <br />Q Monitoring Well/Soil Boring Inspection Report <br />Date: b Inspector: �'Jwn CONSTRUCTION <br />Facility Address: 1 2 C <br />Well Address: LP U 5q 6300Z Total Depth: I� 6 <br />WP# 003g' �-24 Well#: Drilling Rig Type: '� l lJ <br />SA <br />Soil Boring#: I <br />Drilling Company: Ir'Iv.i � <br />Min 2" Annular EHD Seal Verified: El Yes El No <br />�� <br />Driller Onsite:fes, bQ X'-�. <br />Screen Length From: To: <br />Consultant: �� r -r a( 6-Y\ Filter Pack From: To: <br />Geologist: A/rvl-� Bentonite From: To: <br />p7j Grout From: To: <br />Public Water System Onsite: ❑ Yes L3No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes [Z/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 El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: A wti <br />Grout Material: eA� <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout <br />/❑Over Drill <br />❑ Gravity I�remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />#sags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />tL <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 />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 40 80 8 <br />i i 0/16/2017 <br />i b S <br />1868 E. Hazon Avenue I Stockton, California 95205 1 T 209 468-3420 11 F 209 64-0138 I www.sicehd.com <br />