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SANJOAQUIN <br />COUNTY <br />••gr�F�py: Greo'tness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />am <br />Date: Zl% z( Inspector: J? (kr CONSTRUCTION <br />Facility Address: _C W9- C Ot0/el/y&ji-i <br />Well Address: Total Depth: <br />WP# Well#: Drilling Rig Type: <br />Soil Boring#: l <br />Drilling Company: <br />Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: �, "I 5,H t�x Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <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: <br />SPOILS <br />Contamination Noted <br />If yes, spoils storage Location: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 14 °liCpL.^rfev� <br />Grout Material: 71 ewt C e -A e?r <br />Gallons of Grout Used: -2v . ,^u j %, �--� <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ®ring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />�Mravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Ba s <br />Thickest Thinnest <br />2.5 s <br />9 Bags <br />1 <br />Thickest Thinnest <br />ttBags <br />s 1 10 <br />i <br />5 <br />A <br />2 <br />10 1 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <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 />B <br />40 <br />80 <br />8 <br />casing <br />• � heig3iC ' <br />A130VE-63AWND GiiAtS2Y-BOX <br />coMPi snoN COMPLErioN <br />GroUrxi surface + �.. <br />flrout <br />ft. <br />tt. <br />tt. <br />x- o <br />G <br />sloned _ <br />sec on x{ <br />" ynvnt 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 />Bentonite/Cement Mix 3% Mix a% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 lb 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 />