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SAN JOAQUIN <br />Lq <br />L_ , --- COUNTY -- <br />':q Greatness grows her.. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: oc 2 6 Inspector: / a.CONSTRUCTION <br />Facility Address: S S d <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: -I =Z <br />Drilling Company: CrsVM TQC_ <br />Driller Onsite: <br />Consultant: Zrl't e <br />Geologist: (/� (1 <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />Public Water System Onsite: ❑Yes ❑No COMPLETION <br />Domestic Well Onsite: ❑Yes ❑No <br />If yes, location and distance: <br />�onnpi Inl� <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes El <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />No <br />❑ Yes ❑No <br />From: <br />To: <br />From: <br />To: <br />From: <br />To: <br />TI: Fro: <br />To: <br />❑ Stove Pipe ❑Christie Box <br />V :Opp <br />:. <br />COMPLEMN <br />. <br />l Sufl" <br />`V <br />jL <br />❑ Yes ❑No �- 1 . <br />GROUTING or DESTRUCTION Total epth <br />Depth to Water: �. S <br />c P7 Z' <br />Grout Material: <br />Gallons of Grout Used: ^-• 1 Ll 4 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation�Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Li <br />Gravity �Tremie ❑Other: <br />Water Cement 71b Water Cement 941b <br />allons Bas all <br />3s' <br />M <br />tt. <br />3°1° Mix <br />5% Mix <br />ons <br />Ba s <br />Thickest <br />Thinnest <br />ttBags <br />4.7 <br />Thickest <br />Thinnest <br />#Bags <br />2.5 <br />1 <br />5 <br />10 <br />1 <br />s <br />110 <br />2 <br />10 <br />20 <br />2 <br />7,5 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />3s' <br />M <br />tt. <br />cn�.+ paac <br />IF tt. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />BentonitefCement Mix <br />3°1° Mix <br />5% Mix <br />Bentonite per 4i Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2,821 <br />4.7 <br />slottad <br />sac5an <br />cn�.+ paac <br />IF tt. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />BentonitefCement Mix <br />3°1° Mix <br />5% Mix <br />Bentonite per 4i Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2,821 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � S%ckton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />