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SANJOAQUIN <br />—COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: gq Inspector: FX41410' <br />Facility Address: 3,:;!-A e , <br />Well Address: <br />WP#Well#: <br />Soil Boring#: 1 <br />Drilling Company: T�JG <br />Driller Onsite: �p <br />Consultant: Ir imZc.vl A 2x,Lv-- S Yom(, <br />Geologist: 1, )cwy mrio <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑No <br />SAMPLING <br />Thickest Thinnest <br />9 Bags <br />Holding Temperature: <br />H Bags <br />2.5 5 <br />Method: <br />s 10 <br />1 <br />Screening Method: <br />2 <br />10 20 <br />Verified Chain of Custody: <br />❑ Yes <br />❑No <br />SPOILS <br />3 <br />10 20 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />5 <br />�5 <br />Covered: <br />❑ Yes <br />❑No <br />If yes, material: <br />6 <br />17.5 35 <br />GROUTING or DESTRUCTION Total Depth: I O <br />Depth to Water: 113,0LS <br />Grout Material: T�pt�- (` A-j1JA �- <br />Gallons of Grout Used:T c7 <br />❑Well Installation ❑Well, Destruction <br />❑Boring Installation Wring Destruction <br />nnr:Tunn 1lcGn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity XT= ❑Other: <br />Water <br />gallons <br />Cement 47lb <br />Bags <br />Water <br />wallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />9 Bags <br />Thickest Thinnest <br />H Bags <br />2.5 5 <br />1 <br />s 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 <br />3 <br />10 20 <br />4' <br />20 <br />4 <br />12.5 25 <br />5 <br />�5 <br />5 <br />15 30 <br />6 <br />30 V40 <br />6 <br />17.5 35 <br />7 <br />35 <br />7 <br />20 40 <br />8 <br />40 <br />8 <br />CONSTRUCTION <br />Total Depth:_ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To:- <br />To: <br />o:To: <br />To: <br />❑Christie Box <br />casing <br />height <br />7 <br />ABOVE -GROUND <br />COWLETJON CHRISTY-3ox <br />COMPLEiON <br />Grncirad Surfxs <br />groat <br />• <br />0 <br />slot -ad — <br />sac�on <br />9r.v.t Fx" <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 1.411 2.47 <br />Bentonite per 94 lb 2.821 4.7 <br />t <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />