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-ft. <br />stottad <br />sacton <br />SANsJOAQUIN <br />COUNTY <br />Greatness grows here, <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Verified Chain of Custody: 0 Yes ENo <br />SPOILS <br />Contamination Noted: n Yes EiNo <br />If yes, spoils storage Location: <br />Covered: LI Yes ELNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth :.S S t i.Ac. ( *0 <br />Depth to Water: V*. <br />Grout Material: .1•1.e..4.'S <br />Gallons of Grout Used:\---"s vc)-1) <br />Eli Well Installation LI Well Destruction <br />Date: <br />Facility Address: <br />Well Address: <br /> We11#: ,D/(s <br />Soil Boring#: tsY <br />Drilling Company: \i.se...s col \-SN' crAc.9 <br />Driller Onsite: <br />Consultant: Kv_tcs <br />Geologist: <br />Public Water System Onsite: Yes 1K-No <br />Domestic Well Onsite: Yes 'No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />EBoring Installation I Boring Destruction <br />METHOD USED <br />EPressure Grout 1110ver Drill <br />II Gravity ?Tremie 1110ther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest II 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 liso-) (-16 40 80 8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: LI Yes 0No <br />To: <br />To: <br />To: <br />To: <br />COMPLETION 0 Stove Pipe EIChristie Box <br />casing <br />height <br />CHFILS7Y-BOX <br />COMPLETION <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank <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 />BentonitelCement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />o tto <br />Inspector <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />Feet Screen Feet <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com