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SAN.JOAQUIN Environmental Health Department <br />—COUNTY— <br />Greatness grows fere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: W I 1 I ty Inspector: L..r JVD.' CONSTRUCTION <br />Facility Address: Na,-� 0r"04,,—So., <br />Well Address: Total Depth: <br />WP# oon-11-1 Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: 4.1aadwoy-tl Min 2" Annular EHD Seal Verified: El Yes ❑No <br />Driller Onsite: (Za Ifik I �1an lr <br />Screen Length From: To: <br />� Filter Pack From: To: <br />Consultant: k\,e..n �'e lA.•,� '.c_ <br />Geologist: G- Bentonite From: To: <br />—� Grout From: To: <br />Public Water System Onsite: El Yes ❑No 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 />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: S <br />Depth to Water: <br />Grout Material: I\_t""k <br />Gallons of Grout Used: See, -f- I SG <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Goring Destruction <br />METHOD USED <br />❑Pressure Groutt�❑l�Over Drill <br />❑ Gravity remie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Rallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10' <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />casing <br />height <br />ABOVE -GROUND ttsri sox <br />COt F'Ll=i{ON COMPLEMN <br />Ground sumacs <br />grout <br />ft- <br />tt. <br />f3. <br />.AF = <br />4?: _ <br />310tt2d = <br />sr_9cn — <br />gzvw r-% <br />tt. =IFtt. <br />MATERIALVDEVELOPM ENT <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 />Benton itefCement 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />