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SANr;10AQUIN <br />Environmental Health Department <br />—COUNTY= <br />Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �l Z Z <br />Inspector: SL`3 <br />Facility Address: ,3 <br />$ 3y NL 2J-%'-9b5{-eV <br />Well Address: <br />Thickest Thinnest <br />WP# n <br />Wellir <br />Soil Boring#: M <br />— <br />Drilling Company: <br />10 <br />Driller Onsite: <br />10 20 <br />Consultant: <br />75 <br />Geologist: <br />3 <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes []No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: I S <br />Depth to Water:_Io <br />Grout Material: 9? vU- L20, <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation �$oring Destruction <br />METHOD USED <br />❑Pressure Grout Drill <br />El Gravity ?L�LTremie ❑Other: <br />Water <br />Rations <br />From: <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement Mb <br />Ba s <br />Thickest Thinnest <br />k, Bags <br />Thickest Thinnest <br />5 1 10 <br />,7 Bags <br />1 <br />2.5 5 1 <br />5 <br />10 <br />2 1 <br />10 20 <br />2 <br />75 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />735 <br />70 <br />7 <br />20 <br />40 <br />91 <br />40 1 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND <br />COMPLETION cHamrY-aox . <br />COMPLETION <br />Gror9nd Su sacs <br />grout <br />ft- <br />-M <br />ft. fi. <br /><� a <br />-- o <br />:tafjtnd �� <br />inn Ys • : �rawi p�xit <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/Gement Mix 3% Mix_ 5% 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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />