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SANrJ0A0UIN <br />Environmental Health Department <br />h•:�'' COUNTY— <br />�� <br />)Vater <br />gallons <br />Greatness grows here. <br />Thickest Thinnest <br />Monitoring Well/Soil <br />Boring Inspection Report <br />-71 I.-)- <br />2.5 <br />Date: Inspector: IVLQ <br />CONSTRUCTION <br />FacilityAddress: A --T <br />1 <br />Well Address: <br />Total Depth: <br />WP# Well#: <br />Drilling Rig Type: <br />Soil Boring#: <br />7.5 <br />Drilling Company: 1 r T/JC <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Driller Onsite:-iAaAA, 6MV1C.c� <br />Screen Length From: To: <br />Consultant: Ge.<STe e- C, <br />Filter Pack From: To: <br />Geologist: N-A1Ill <br />Bentonite From: To: <br />4 <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes ❑No <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Ver -died Chain of Custody: <br />SPOILS <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth./ I 1/Z/ <br />Depth to Water: onL <br />Grout Material: <br />Gallons of Grout Used: ?5H <br />❑Well Installation ❑Well- Destruction <br />❑Boring Installation Xoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 1Tr ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />)Vater <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ti Bags <br />Thickest Thinnest <br />riBags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <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 />15 <br />30 <br />6 <br />30 60. <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 1 <br />40 <br />8 <br />40 80 <br />8 <br />-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 lb 2.82 4.7 <br />t � <br />5 gal 6 0a - ff� vk, 10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, Calitomia 105 1 T 209 468-34201 F 209 464-x138 1 mvw.sicehd.com <br />