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SAN J OAQ U I N Environmental Health Department <br />- COUNTY= <br />G -eatnes5 qroys herr <br />Monityori1ng�lWell/Soil Boring Inspection Report <br />✓ <br />Date: /Z� , Inspector: /J1l. ( CONSTRUCTION <br />Facility Address: at''xet 10Cr'_ (Z' <br />Well Addre Total Depth: <br />WP# 1 Well#: Drilling Rig Type: _ <br />Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: <br />Driller Onsite: pot, wJ-� <br />Screen Length <br />From: <br />To. <br />Consultant: <br />Filter Pack <br />From: <br />To: <br />Geologist: <br />Bentonite <br />From: <br />To: <br />10 <br />Grout <br />From: <br />To: <br />Public Wafter System Onsite: 17-1 Yes [I No <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑ No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />v � <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 601 <br />Grout Material: to 6 <br />Gallons of Grout Used: '-- v M40 :-5 <br />❑Well Installation ell Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />gallons' <br />Cement 471b <br />Bas 11 <br />Water <br />Rallons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br />4 Bags <br />Thinnest <br />4 Bags <br />z.s s <br />1 <br />10 <br />1 <br />s 10 <br />2 <br />20 <br />2 <br />7.5 15 <br />3 <br />6Thickest <br />30 <br />3 <br />10 20 <br />4 <br />40 <br />4 <br />12.5 25 <br />5 <br />50 <br />5 <br />15 30 <br />6 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />casing <br />height <br />ABOVS.&ROUND <br />CowLETION C 1RMTX-80X. <br />COMPLET ON <br />Ground SLxiacs <br />grow <br />it. <br />w o <br />- a <br />sloiind _ S <br />sawn _— <br />graved Fads <br />ft. <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/Gement Mix 3% Mix 5% Mix <br />Eieiiionite per 47 Ib — -- 1.4'1 2.41 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />