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SAN;JOAQUA <br />Envir®nmen�ai Health Department <br />- <br />COUNlTY-- <br />G;eatness grows he e. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Id Al 0, Inspector: 5. Q6yL-, <br />Facility dres : 6C1S4 W'gVC-R1.Y &4L-UOiW,P,* 4S43�- <br />Well Address: A*Ir. <br />WP# OnQ3K1'3 Well#: Mw -:3 - <br />Soil Boring#: <br />Drilling Company: (;r -6C Og-1-Lt3NG <br />Driller Onsite: Vf AYNE <br />Consultant: <br />Geologist: Aa y pR6E <br />Public Water System Onsite <br />Domestic Well Onsite: <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 />Covered: <br />CONSTRUCTION <br />i <br />Total Depth: <br />7j— <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: ---1+A <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: _ <br />GROUTING or DESTRUCTION Total Dept' <br />v <br />Depth to Water: <br />Grout Material: h)6A'r fia)— <br />Gallons of Grout Used: <br />//Well Installation ❑Well Destruction <br />❑B_oring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity �remie <br />❑Other: <br />Water <br />allonsgallons <br />Cement 471b <br />Water <br />Cement 941b <br />Bags <br />Thickest <br />iinnest <br />#Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 1 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 1 50 <br />5 <br />15 <br />30 <br />6 <br />30 1 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />3 <br />40 0"0 <br />9 <br />cas be igh't <br />be ig nt <br />T <br />—0— Hat <br />ABOVE-uatCUND Ct ns�ii 60X <br />CC4SPV. EMN CDt tri �io`i <br />grout <br />tt. <br />a <br />stot`.gv <br />❑ Yes ❑No <br />To <br />To: <br />To: <br />To: <br />❑Christie Box <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />f. <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: 33 <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement 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 952.05 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />