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IV <br />SANsd0A0UIN <br />—COUNTY— <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /(� Z Inspector: J1,33YLK4' <br />Facility Address: 61..5 TGLi n S S t zv_6Cfa ti` <br />Well Address• ^— <br />WP# n�Y �� b Well#: <br />Soil Boring#: <br />Drilling Company: j 1 6 -(e -- <br />Driller Onsite: <br />Consultant: Ad_Vr,,-cC Cv <br />Geologist: 0. V I I I ovI'\ k C-wl- <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes ❑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: kYes ❑No <br />If yes, spoils storage Location: P fkr, <br />Covered: �'es ❑ No <br />If yes, material: I"ri L,J% I.IC/l <br />GROUTING or DESTRUCTION Total Depth: 4611 <br />Depth to Water: 2,5 <br />Grout Material: Sys be -^,td '('�;L_ <br />Gallons of Grout Used:—'fO ZL( <br />❑Well Installation Rrkell Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout &,Over Drill <br />❑ Gravity 'U'fremie ❑Other: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes 11 No <br />Screen Length <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Ba s <br />Thirkest <br />Z S <br />Thinnest <br />Bzgs <br />1 <br />Thickest Thinnest <br />5 lU <br />:76ags <br />1 <br />5 <br />10 <br />z <br />10 2 <br />2 <br />7.5 <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 />7 <br />35 70 <br />7 <br />20 <br />1 40 <br />8 <br />1 40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes 11 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 C iRZTY-Box. <br />COMPLETION COMPLETION <br />Ground sartxe <br />grout <br />ft. <br />ft. <br />ft. <br />alottad — <br />arc9on <br />griwl pack <br />s <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 />BentonitelOement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />{ <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />