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-.' SAN JOQQUIN Environmental Health Department <br />i —COUNTY= <br />Greatness grotvs here- <br />/ Monitoring Well/Soil Boring Inspection Report <br />Date: 9( Z, � Inspector: 6 CONSTRUCTION <br />Facility Address:_SSW T. 5VOC IO'" <br />Well Address: Total Depgh:ype Z� /01 � va Lv`� v� <br />WP# V 2�Z2. Well#: -- Drillin gRi T e: 1, <br />Soil Boring#: "' <br />Drilling Company: L^ r/j_A."'CC Min 2" Annular EHD Seal Verified: Yes El No <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grouk('o) From: -)o To: O <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 />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑ 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: 3)0, <br />Depth to Water: <br />Grout Material: (0 3 3& sxoi Cut <br />Gallons of Grout Used: 2L <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />rLET99e111Mu111N09 DI <br />❑Pressure Grout Dover Drill <br />❑ GravityTremie ❑Other: <br />Water <br />gallons <br />' <br />Cement 47 lb <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />2.5 s <br />It Bags <br />1 <br />Thickest Thinnest <br />s 10 <br />4 Bags <br />1 <br />s 1 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />1s <br />3 <br />15 <br />3o <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />s0 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />10 <br />40 <br />8 <br />40 <br />80 <br />8 <br />casing <br />height ' <br />AWVE-GROUND . W <br />COWLE1710N G4iR1SiY-BOX . <br />COMFLEnic3rorirsd Su-faca - <br />grout <br />ft_ <br />,tire`- O <br />s: w <br />.o <br />atattncJs —' E <br />aac n <br />pack <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 />BentoniteXement Mix 3% Mix <br />Bentonite per 47 Ib 1.4'1 <br />Bentonite per 94 Ib 2.821 <br />i <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 4640138 1 www.sicehd.corn <br />