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`-`€`� �'SANJOAQUIN <br />Environmental Health Department <br />—COUNTY= <br />Gre otne,s grows here <br />/ <br />Monitoring Well/Soil Boring Inspectio �/, <br />Date: X13010 Inspector: �L`SJ CKGr CONSTRUCTION l "��� <br />Facility Address: ,�2YUoKS►O�e ��Ctv - <br />Well Addre s: r' Total Depth: � / <br />WP#- yVUS Well#: - Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified <br />Drilling Company: 7T(Co i <br />Driller Onsite: O'tSG-V6t- � Screen Length From: <br />Consultant: 'm yy0.S ► 0 ,Vje cia l e-_�ilter Pack From: <br />Geologist: Bentonite From: <br />Grout From: 1 <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 />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes El No <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />Cement 941b <br />ea s <br />Depth to Water: <br />M — <br />To:� <br />�vro -C�1���t <br />❑Christie Box <br />—Z— casing <br />height <br />1180VE-GROUND <br />CONF'LE ON C4iAISTY-80X. <br />comPL.ETION <br />Ground swaca <br />prctrt <br />tt_ <br />tt_ <br />ft. <br />_ a <br />- C <br />Covered: Yes El No si­+tom <br />If yes, material: <br />Cement 471b <br />Baas <br />GROUTING or DESTRUCTION Total Depth: <br />Cement 941b <br />ea s <br />Depth to Water: <br />M — <br />Grout Material: d- -t() 'Lli <br />�vro -C�1���t <br />MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: —.:Yo g- OL W 10 <br />ell Installation ❑Well Destruction <br />Casing Type: <br />Blank Feet <br />❑Boring Installation ❑ Boring Destruction <br />Slot Size: <br />Size: <br />10 <br />Bags Cement: <br />METHOD USED <br />Bags Sand/Gravel: <br />15 <br />Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill <br />Filter Pack Type/Size: <br />El Gravity Premie []Other: <br />of Method: <br />Water <br />gallons, <br />Cement 471b <br />Baas <br />Water <br />a] ons <br />Cement 941b <br />ea s <br />Thickest Thinne<t <br />9Bags <br />Thickest <br />Thinnest <br />IBags <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7,5 <br />15 <br />3 <br />15 <br />1 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 />ft. <br />Screen Feet <br />13entonitefCement Mix 30/. Mix_ w. Mix <br />Lofliorlife P81, '11 Ib---- -- -1.4,1 2. 4l <br />Bentonite per 94 Ib 1 2.821 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 />