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SANJOAQUIN <br />Environmer Health Department <br />—COUNTY— <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: N I i-1 wy Inspector: Low CONSTRUCTION <br />Facility Address: rr0 t.a S ro„ <br />Well Address: Total Depth: <br />WP# Well#:mow-yd r�_U Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: ptAr%eC.ar-*, <br />Driller Onsite: rnw✓\ --r <br />Consultant: f-1 <br />Geologist: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance <br />SAMPLING <br />Holding Temperature: <br />Method: <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 />❑ Yes 11 No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <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 />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />caeing <br />height <br />AWVE-GaouND <br />CowLETION Ct 1:StY-sox <br />COMPLETION <br />Ground SLOW* <br />gr <br />ad <br />ft. <br />tt. <br />ft. <br />'3J <br />�0: _ a <br />— m <br />0 <br />siottad '— <br />tsc�en <br />gv­ pvck <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 3L0,.1 —- <br />Grout Material: Y%_u _ 041_1�— <br />Gallons of Grout Used: XD MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation E9�ell Destruction Blank FAn* <br />❑Boring Installation ❑Boring Destruction <br />P,APTWnn I KU) <br />❑Pressure Grout <br />2/over Drill <br />1� <br />❑ Gravity &tremie ❑Other: <br />Water <br />allons <br />Cement 47 lb <br />Bas <br />Water <br />aallon5 <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ilBagsThickest <br />Thinnest <br />ilBags <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 />is 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 />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 13%M 5% Mix <br />Bentonite per 47 Ib1.41 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />i <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />