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//c°1 SAN JOAQUIN <br />Environmental Health Department <br />COUNTY - <br />uleutness grows lie!! <br />Monitoring Well/Soil Boring Inspection Report <br />Date:6 11-1/2.1 Inspector: <br />Facility Address: 0 A--; ice) <br />Well Address: <br />WP# 1 15 <br />Soil Boring#: <br />Driller Onsite: <br />9;ar-;iJ <br />1(r7 vn y <br />Public Water System Onsite: <br />Well#: <br />s 0r/0\. CONSTRUCTION - <br />/-.--9"u:/e. 4 ve <br />Total Depth: <br />Drilling Rig Type: 14-3 /i <br />Consultant: <br />Geologist: <br />Drilling Company: I 0-43er- I ‘( Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />Min 2" Annular EHD Seal Verified: CI Yes EINo <br />To: <br />To: <br />To: <br />To: <br />From: <br />From: <br />From: <br />From: <br />LIl Yes EN° COMPLETION 111 Stove Pipe EIChristie Box <br />Domestic Well Onsite: CI Yes ON° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: CI Yes lilNo <br />SPOILS <br />Contamination Noted: ID Yes El No <br />If yes, spoils storage Location: <br />Covered: LlYes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: Li4‹ <br />Depth to Water: U44 17 -poi <br />Grout Material: <br />Eli Well Installation <br /> III Well Destruction <br />LIBoring Installation <br />METHOD USED <br />EPressure Grout IllOver Drill <br />LI Gravity <br /> kremie E0ther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest k Bags Thickest Thinnest 4 Bags <br />2.5 5 1 5 10 1 <br />5 10 z 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 b 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />casing <br />height <br />C1FILSTY-BOX <br />COMPLET1CN <br />ft <br />,lc ttad <br />itactc n <br />ft <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 />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 />Gallons of Grout Used: <br />no oring Destruction <br />ABOVE-GROUND <br />COMP LET 10 N <br />10/16/2017 <br />qa a`11 I <br />1868 E. Hazelton Avenue I St ckton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com