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SANJOAQUIN <br />—COUNTY— <br />�. <br />J?OAS: GrB;7tnt'i5 grows ftere. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:?/'f0yl In ecto . CONSTRUCTION <br />Facility Address: <br />Well Address: Total Depth: <br />WP# 66 Well#:�1 ,Z,� Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: <br />Drilling Company: <br />❑ Yes ❑No <br />Driller Onsite: Screen Length <br />From: <br />To: <br />Consultant: Filter Pack <br />From: <br />To: <br />Bentonite <br />Geologist:WK <br />From: <br />To: ` <br />Grout <br />From: <br />To: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />CAnnPI IIVr, <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 />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes 11 No <br />GROUTING or DESTRUCTION Total Depth: (C) <br />Depth to Water: ptr,159--� <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation *Well Destruction <br />El Boring Installation Aoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />V1 Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br /># Bags <br />Thickest Thinnest <br />ti Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />15 <br />15 <br />30 <br />3 <br />1 20 <br />20 <br />40 <br />4 <br />2. 25 <br />25 <br />50 <br />5 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />fo <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />tL <br />MATERIALS/DEVE LOIPM 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 />BentoniteXement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 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 />