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SAN JOAQUIN Environmental Health Department <br />-COUNTY-grnrvs !;ere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Oh Inspector: V Vr J YC kt CONSTRUCTION <br />r <br />Facility Address: ZSS�� S Z'�-e✓ <br />Well Address: — Total Depth: <br />WP#2 2 Well#: Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified <br />Drilling Company: k e-1 -- 6V055 <br />Driller Onsite: �� {-� G V'oO i -i', Screen Length From: <br />Consultant: Filter Pack From: <br />Geologist: Bentonite From: <br />Grout From: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperatu <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes El No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: .3u <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 4716 <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />2.5 5 <br />k Bags <br />1 <br />Thickest Thinnest <br />5 10 <br />n Bags <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />is <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 1 <br />40 1 <br />3 <br />40 <br />80 <br />8 <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 50% Mix <br />k3entonite per 47 Ib 1.4'1 2.47 <br />Bentonite per 94 Ib 2.821 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 />