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SANsJOAQUIN <br />COUNTY <br />Greatness grows herr. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2 Inspector: �. CONSTRUCTION <br />Facility b Address: al W Hwv I'Z <br />Well Address: Total Depth: <br />WP#_ _00 '1 LH!j Well#: Drilling Rig Type: <br />Soil Boring#: 197 _2Z Min 2" Annular EHD Seal Verified: <br />Drilling Company: <br />❑ Yes ❑ No <br />Driller Onsite: Screen Length From: To: <br />Consultant: U'Vl �/Q/h ;S ��d�w¢G7� Filter Pack From: To: <br />Geologist:j/C t: VY1 Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />CAMPI IIVh <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 />❑ Yes ❑ No <br />casing <br />height <br />ABOVE -GROUND CHRZT'Y43OX <br />0016FLEfION COMPLETION <br />Ground Surface <br />grout <br />❑Yes ❑ Nb' <br />stoned 8 <br />an <br />❑ Yes El No gr," <br />If yes, material: 19 T /O D <br />GROUTING or DESTRUCTION T a Depth: <br />Depth to Water: A X26 yl n' <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />MFTWnn I ICFs <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />aBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 M5 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />MATERIALS/DEVELOPMENT <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 />Bentonite/Cement Mix 3% Mix 3% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />