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SANJOAQUIN <br />Environmental Health Department <br />'J —COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: N 0)k3Inspector: <br />Facility Address: 2tio�j 0, oq- <br />Well Address: <br />WP# Well#: <br />Soil Boring#:'GS_-�,2- <br />Drilling Company:Qi�Gccrir� <br />Driller Onsite: c3e�-Q*C's�Q�i Ci <br />Consultant: C�Q/Q-iPcc <br />Geologist: IAS&LAkk) <br />Public Water System Onsite: � Yes []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 <br />Cprlll C <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:�Q'�5" <br />Depth to Water: � L5 <br />Grout Material: N Lc1-\,FP 'Ic- <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation VBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity iTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />Rallons <br />Cement 941b <br />Baps <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 so <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 70 <br />7 <br />20 0 <br />8 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />[�Ii7►�il»��[�7►1 <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />ft. <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 />BentonitefCement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 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 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />