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'SANJOA0UIN <br />;.;. Environmental Health Department <br />i —COUNTY= <br />Greatness r o I - <br />Monitoring Well/Soil Boring Inspection Report <br />Date: _ <br />Inspector: SE`S 3'/CKl <br />Facility Address: ZjQ <br />N, 2LCKeV ryya.4^ ` cL <br />Well Address: <br />Cement 941b <br />BaR5 <br />WP# Oo U <br />Well#: �— <br />Soil Boring#: --- <br />9 Bags <br />Drilling Company: Co ff <br />Driller Onsite: <br />Consultant: ^ <br />Geologist: <br />5 <br />Public Water System Onsite: ❑ Yes [I 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 ❑ No <br />cpnn c <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: N'prRev <br />CONS IRUCT ION Clit-ti10Z,'I-- <br />Total Depth: <br />3ool <br />Drilling Rig Type: c_ VC)t&yy <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From:To: <br />Grout From: 30 To: — <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height " <br />ABOVE GROUND <br />c063 LETION CHRSSiXBOX. <br />CTiA_ N <br />Ground surto <br />groat <br />tt_ <br />ft. <br />-Y - <br />- O <br />alssttnd � — .� <br />tacden — <br />': VXVw pads <br />GROUTING or DESTRUCTION Total Depth: 7Wffi <br />Depth to Water: to" `= —" <br />Grout Material: rO e,-� CP_v,.e.,& C S`y 6-e-4-,,. IV <br />MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: `30 c, -G-(. <br />Casing Type: <br />.Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation ❑ Slot Size: <br />Boring Destruction Bags Size: <br />Cement: <br />METHOD USED Bags Sand/Gravel: <br />❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />❑ Gravity XTremie ❑Other: Type of Method: <br />Water <br />allons' <br />Cement 47 lb <br />Bas <br />Water <br />eallons <br />i <br />Cement 941b <br />BaR5 <br />Thickest Thinnest <br />4 Bags <br />Thickest Thinnest <br />9 Bags <br />9---1--- <br />5 <br />10 <br />2 <br />10 <br />20 1 <br />2 <br />75 <br />15 <br />3 <br />15 <br />30 1 <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 />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 />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />Screen Feet <br />Bentonite/Cement Mix_ 3% Mix 5% Mix <br />Berlionite per 47 Its 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 />