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SAN JUMIN <br />Environmental Health Department <br />�'•` 'J —COUNTY— <br />c Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: )117/11 r Inspector: 49— <br />Fa cil ity <br />L -Facility Address: 11) <br />Well Address: <br />WP#_3 Zei Well#: <br />Soil Boring#: 1 (3 <br />Drilling Company: r-Wa et- T� ,•�..-� f s. h-�-1 <br />Driller Onsite: ZY425L, <br />Consultant: <br />Geologist: <br />Public Water System Onsite: . ❑ Yes ❑No <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: <br />SPOILS <br />Contamination Noted <br />If yes, spoils storage Location: <br />❑ Yes ❑ N o <br />❑ Yes El No <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: `3 <br />Depth to Water: <br />Grout Material: V��4A- r►s <br />Gallons of Grout Used: /%, xVq . <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation .boring Destruction <br />METHOD USED <br />❑Prre�essure Grout Dover Drill <br />LsLGravity ❑Tremie ❑Other: <br />Water <br />gallons <br />From: <br />CemES <br />Water <br />allons <br />Bentonite <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />From: <br />Thickest Thinnest <br />7t Bags <br />2.5 <br />5 <br />5 <br />10 <br />1 <br />5 <br />10' <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />15 <br />30 <br />3 <br />10 <br />20 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />25 <br />50 <br />5 <br />15 <br />30 <br />3o <br />60 <br />6 <br />17.5 <br />35 <br />35 <br />70 <br />7 <br />20 <br />40 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: — <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />COMPLETION ❑ Stove Pipe <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />a=3.ng <br />height <br />Zvi_ GROLNo cc �a�srr sox <br />� � COMPLETiON <br />grout <br />I <br />#L <br />:Ar _ <br />= Q <br />'{ = a <br />niaY241 _ <br />soon _ <br />MATERIALS / D EV E LOP M 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 />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 />3 ':�4 (� 615- 1 z 9 11,,0 1/1 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T'209 468-34201 F 209 464-0138 1 www.sicehd.com <br />