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SAN JOAQUIN <br />"'-—COUNTY— <br />P' Greatness groves here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �1 Inspector: �� 4�i CONSTRUCTION <br />Facility Address: <br />WellAddress: <br />WP# Q0 � Z 917 Well#: <br />Soil Boring#: <br />Drilling Company: (�i, IkIl e-PCASores S -rylC <br />Driller Onsite: -2 (UGi PY 'h G1 <br />Consultant: <br />Geologist: <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 />If yes, material: <br />Total Depth: — <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: Z ys/ <br />Depth to Water: — <br />Grout Material: Io• . >U -Y. ce�1`iL' <br />Gallons of Grout Used: — <br />❑Well Installation `RlWell Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity .�RTremie --f!lDther: Gti t <br />Water <br />allons <br />3% Mix <br />1.41 <br />471b <br />Ceme�as <br />B <br />Water <br />gallons <br />2.82 <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />2.5 5 <br /># gs <br />1 <br />Thickest Thinnest <br />5 10 <br /># Bags <br />1 <br />5 <br />10 <br />_ <br />2 <br />10 <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 />8 <br />40 <br />80 <br />8 <br />❑ Yes 11 No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <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 />it. <br />Screen Feet <br />Bentonite/Cement Mix <br />Bentonite per 47 Ib <br />3% Mix <br />1.41 <br />5%, 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 />