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cas ing <br />height <br />ABOVE-GROUND <br />comPLErioN <br />ri• SANJOAvUIN Environmental Health Department (:1 74i1 -COUNT <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 6 <br />Facility <br />Well Add <br />WP# <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: 111 Yes ILINo <br />Domestic Well Onsite: Yes ONo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes 0N0 <br />SPOILS <br />Contamination Noted: LI Yes 0 No <br />If yes, spoils storage Location: <br />Covered: <br /> 0 Yes IIINo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: t <br />Grout Material: Pietuf <br />Gallons of Grout Used: <br />1141 Installation El Well Destruction <br />LI Boring Installation 0 Boring Destruction <br />METHOD USED <br />0Pressure Grout DOver Drill <br />DIX:avity 0Tremie 00ther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 I 8 40 80 a <br />CONSTRUCTION <br />Total Depth: 7,S <br />Drilling Rig Type: ?drjle.-) <br />Min 2" Annular EHD Seal Verified: 0 Yes LIN° „...._ k <br />Screen Length From: 1..4C I To: (.5 i Filter Pack From: z_4' To: ;,LS: <br />Bentonite From: S, ( To: <br />Grout From: 7,-, 5--- To: <br />COMPLETION 7 Stove Pipe 11<hristie Box <br />MATERIALS/DEVELOP,NT <br />Casing Type: J <br />Blank Se- Feet Screen 22 Feet <br />Slot Size: 0/0 <br />Bags of Cement: <br />Bags Sand/Gravel: / <br />Type/Brand of Bentonite: ,d; <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />Inspector: <br />2_,zir sr-- <br />- <br />10/16/2017 <br />1868 E. Hazelton Avenue J stockton, Calfornia 95205 1 T 209 468-3420 I F 2G9 464-01 38 I www.sicehd.com <br />3// h