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SANrJoAQU N Environmental Health Department <br />t _ COUNTY— <br />Greatness gr ws Fere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �/ /[ �' Inspector: C CONSTRUCTION <br />Facility Address: 235o() Y -Q- Wcl( •, %e- 4-7 <br />Well Address: Total Depth: 661 <br />WP# oq Well#: Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Drilling Company: C2&10(K <br />Driller Onsite: Screen Length From: To: <br />Consultant:AV ^ (,(j�,..S ri�U G h-0 Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grout From:f'1 To:�3 <br />Public Water System Onsite: El Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑ No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperate <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />casing <br />height <br />ABOVE -GROUND <br />COWL1=TION CHR1S7Y-BOX . <br />COMP=ON <br />cekncir)d Suriaca <br />grout <br />ff. <br />ft. � <br />— o <br />slam d _ c <br />sawn — <br />Ifyes, material: <br />GROUTING or DESTRUCTION Total Depth: 6-6 ( Cl�ckke% � g <br />Depth to Water: ft <br />Grout Material: AW LwQ,­t- <br />Gallons of Grout Used: <br />MATERIALS/DEVELOPMENT <br />^— ,S� or Casing Type: <br />ell Installation ❑Well Destruction Blank Feet <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout Dover Drill <br />)eGravity ❑Tremie ❑Other: <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 />BentonitefCement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib --- 1.441 - 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />s <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 />Water <br />a I <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />A Bags <br />Thickest Thinnest <br />4 Bags <br />2.5 <br />1 s 1 <br />1 <br />5 <br />10 <br />1 <br />s <br />1 10 1 <br />2 <br />10 1 <br />20 <br />2 <br />7.5 <br />15 <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 />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 1 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 1 <br />7 <br />20 <br />1 40 1 <br />8 <br />40 <br />80 <br />8 <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 />BentonitefCement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib --- 1.441 - 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />s <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 />