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SAN JOAQUIN Environmental Health Department <br />__..r <br />—COUNTY— <br />Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: C, f-'44,111'' ' CONSTRUCTION <br />Facility Address: )4,5) G2fadt LirnC: .� <br />Well Address: 1) Total Depth: <br />WP# Oyu 7$ Well#: Drilling Rig Type: <br />Soil Boring#: �- )g <br />Min 2" Annular EHD Seal Verified: El Yes 11 No <br />Drilling Company: �',k- <br />Driller Onsite: �i �- Screen Length From: To: <br />,�., ;�,�; <br />Filter Pack From: To: <br />Consultant: S <br />Geologist: 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 />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />El Yes iTNo <br />❑ Yes qNo <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: f �' <br />Grout Material: <br />Gallons of Grout Used: ay <br />❑Well Installation ❑Well Destruction <br />El Boring Installation�Bcring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity KTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />lZaI1111 ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <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 40 <br />4 <br />12.5 <br />25 <br />5 ✓ <br />25 50 <br />5 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 ! <br />35 70 <br />7 <br />8 <br />40 80 1 <br />8 <br />IEEEMI;ia <br />MATERIALS/DEVELOPMENT <br />Casing Type: <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 />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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />