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Inspector: pi/LAIL CONSTRUCTION Date: <br />Facility ddress: <br />Well Address: <br />WP# 00 3 q -73 <br />Soil Boring#: <br />Total Depth: <br />Drilling Rig Type: Went A /, 6 7- <br />SANJOAQUIN <br />COUNTY— <br />crea tness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Environmer Health Department <br />ABOVE-GROUND <br />COMPLETION <br />ca8 tflg <br />height <br />CtSr4Ox <br />COMPLET19N <br />GroUrod Sul-facia <br />Fi r 4 ft <br />slotted <br />Sircton <br />gravs.1 pack <br />ft <br />Drilling Company: /4-6. 5 <br />Driller Onsite: <br />Consultant: /I-4 <br />Geologist: <br />Public Water System Onsite: LI Yes IEINo <br />Domestic Well Onsite: LI Yes 0No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />Yes EINo <br />SPOILS <br />Contamination Noted: 1E1 Yes EiNo <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: / Sv <br />Depth to Water: • <br />Grout Material: <br />Gallons of Grout Used: <br />S." <br />0Well Installation 0Well Destruction <br />111Boring Installation IY;t<ring Destruction <br />METHOD USED <br />Ii1Pressure Grout ElOver Drill <br />Vgravity DTremie DOther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cem ent 94 lb <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest 4 Bags <br />2.5 5 1. 5 10 1 <br />5 10 2 10 20 2 <br />7,5 15 3 15 30 a <br />10 20 4 20 40 4 <br />12,5 25 5 '25 50 5 <br />15 30 a 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION 0 Stove Pipe <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br /> <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 />Yes lEINo <br />El Yes ONo <br />To: <br />To: <br />To: <br />To: <br />ElChristie Box <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />j7e. /1 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />10/16/2017