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SAN."JOAQUIN <br />-> —COUNTY— <br />.} <br />Greotness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: / ( O ZI Inspector: gt8, `1 CONSTRUCTION <br />Facility Address: U• C- ' <br />Well Add re s: Total Depth: <br />WP# 0(-) Z S 3 Well#: 1, , 6) Drilling Rig Type: <br />Soil Boring#: U 0 / Min 2" Annular EHD Seal Verified: <br />Drilling Company: 5/,/6e—o <br />❑ Yes ❑No <br />Driller Onsite: <br />Screen Length <br />From: <br />To: <br />Consultant: LS C— C <br />6VG {7Filter Pack <br />From: <br />To: <br />Geologist: <br />Bentonite <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes 11 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 EJ No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />Grout <br />rnR/IDI FTIniU <br />From: <br />❑ Stove Pipe <br />To: <br />❑Christie Box <br />If yes, material: <br />i <br />GROUTING or DESTRUCTION Total Depth: 7), S� ) 30 <br />Depth to Water: U V 6L—n/ tv'_' n - <br />Grout Material: %% e�7` Ce -nen -"- <br />Gallons of Grout Used: � J Ci -1, MATERIALS/DEVELOPMENT <br />Casin T e: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />cavity �Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Ba <br />50% Mix <br />2.47 <br />Water <br />allons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />s <br />10 <br />1 <br />5 10 <br />_ <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />is 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />g yp <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 />ft. <br />Screen Feet <br />Bentonite/Gement Mix <br />Bentonite per 47 Ib <br />3%_ Mix <br />1.41 <br />50% Mix <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />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 />