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SAN,d0AQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: N.X0P\ \ Inspector. .3611\ <br />Facility Address: Co \c"D'' Q' <br />Well Address: <br />WP# (k,5 Well#: <br />Soil Boring#: 1_5 , •.1%C Lo <br />Drilling Company: <br />Driller Onsite: <br />Geologist: •-'\\ \_>4k..4^t..) <br />Consultant: c,c01)41-4 .5),) <br />Public Water System Onsite: <br /> 0 Yes KNo <br />Domestic Well Onsite: I/Yes 0No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes E No <br />SPOILS \,) <br />Contamination Noted: LI Yes EN° <br />If yes, spoils storage Location: <br />Covered: 0 Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: \D <br />Depth to Water: '.•1.4c 1 <br />Grout Material: I.-) SCAise Qie <br />Gallons of Grout Used: <br />0Well Installation 0Well Destruction <br />0Boring Installation lBoring Destruction <br />METHOD USED <br />E] Pressure Grout 00ver Drill <br />El Gravity VTremie Cl Other: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest Si Thickest Thinnest //Bags <br />2.5 W 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes ONo <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />COMPLETION 111 Stove Pipe 0Christie Box <br />casing <br />height <br />clisisr?-aox <br />COMF'LETIgN <br />-ft <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />Bentoniteleement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />slattkd <br />sicdon <br />ft. <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com