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E <br />N, SAN-,-)OAQUIN Environmental Health Department <br />Irxi —COUNTY— <br />\ti'q� �;s?'' Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: 24- 1^ AA I VLA CONSTRUCTION <br />Facility Address:_ GQ 10 E <br />Well Address: �` Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: 'Al 'qq Min 2" Annular EHD Seal Verified <br />Drilling Company: Wt)" VAJ i (�i 00 r -D <br />Driller Onsite:1=L(Fri (,o Screen Length From: <br />Consultant: GeX7-ev— ':17./jC1 Filter Pack From: <br />Geologist: boji i A Bentonite From: <br />Grout From: <br />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑No <br />SAMPLING <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Holding Temperature: <br />Thickest Thinnest <br />11 Bags <br />Method: <br />5 <br />1 <br />Screening Method: <br />1 <br />5 <br />Verified Chain of Custody: <br />❑ Yes <br />❑No <br />SPOILS <br />7.5 <br />15 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />20 <br />4 <br />Covered: <br />❑ Yes <br />[]No <br />If yes, material: <br />5 <br />25 50 <br />q, <br />GROUTING or DESTRUCTION Total Depth:2()� <br />Depth to Water: in onL <br />Grout Material: ny� <br />Gallons of Grout Used: _IL4 <br />❑Well Installation ❑Well- Destruction <br />❑Boring Installation; Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �j remie ❑Other: <br />\. me O <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 lb 1.41 2.47 <br />Bentonite per 94 lb 2.52 4.7 <br />- P4 0{ 10/16/2017 <br />1868 E. Hazelton Avenue l Stockton, Califomia 95205 1 T 209 468-34201 F 209 464-0138 I www.sicehd.com <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />11 Bags <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 48 <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 <br />40 <br />8 <br />40 80 <br />8 <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 lb 1.41 2.47 <br />Bentonite per 94 lb 2.52 4.7 <br />- P4 0{ 10/16/2017 <br />1868 E. Hazelton Avenue l Stockton, Califomia 95205 1 T 209 468-34201 F 209 464-0138 I www.sicehd.com <br />