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SAN�lOAQUIN <br />�� Environmental Health Department <br />—COUNTY— <br />O4,FbsrP' Greotness grows fere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 111IS(i1 Inspector: S(A-gs�'&I CONSTRUCTION <br />Facility Address: V 170q I GLc'i-r Ic Ave , 1�fockrb -.Y) <br />Well Address: Total Depth: <br />WP# 2 r73 W II#: Drilling Rig Type: <br />Soil Boring#: r5l,61,93 Yb <br />Min 2" Annular EHD Seal Verified: El Yes ❑No <br />Drilling Company: c. r. -� C'U �'e C <br />Driller Onsite: Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: V i C 7"% LV Bentonite From: To. <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distan <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody <br />cpnii c <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes []No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: <br />i <br />GROUTING or DESTRUCTION Total Depth: S <br />Depth to Water: A/o'YLe P_ x (-c ,,-"re✓ee` <br />Grout Material: i e6, -t- C 2 - <br />Gallons of Grout Used: O C410— <br />ti PCY ko (-e— <br />❑Well Installation ❑Well Destruction <br />El Boring Installation.Noring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />9Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />s <br />10 <br />1 <br />5 <br />10 <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 />6 <br />40 <br />80 <br />8 <br />n <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 a% 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 />