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SANJOAQUIN <br />—COUNTY— <br />` T+Y. <br />^CiIIFt�C-�� •' Greatness groves here. <br />Environmental Health Department <br />/, / <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 22- Inspectoo[* nU J L CONSTRUCTION <br />Facility Address: 2 ZZ 6i'& , SbC%«'),N <br />Well Address: — - Total Depth: <br />WP# wq2,9(Well#: Drilling Rig Type: <br />Soil Boring#: C P F-3 G f �—'�— Min 2" Annular EHD Seal Verified: <br />Drilling Company: L <br />❑ Yes []No <br />Driller Onsite: <br />Screen Length <br />From: <br />To: <br />I <br />Consultant:(,L/n" e:EF en I <br />Filter Pack <br />From: <br />To: <br />Geologist: <br />Bentonite <br />From: <br />To: <br />15 30 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes []No <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite <br />If yes, location and distance: <br />❑ Yes ❑No <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 />GROUTING or DESTRUCTION Total Depth: 2(2G <br />Depth to Water: '�- /,3 <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installationoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑ er Drill <br />El Gravity _ Tremie ❑Other: <br />Water <br />gallons <br />3% Mix <br />I ,1 <br />2.821--4.7 <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ti <br />5 10 <br /># Bags <br />1 <br />2 <br />Thickest Thinnest <br />5 <br />10 20 <br />4 Bags <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 />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />B <br />40 80 <br />a <br />MATERIALS/DEVELOPM ENT <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/Cement Mix_ <br />Denioni e per 4Y Ib <br />3% Mix <br />I ,1 <br />2.821--4.7 <br />5% Mix <br />1 i1 <br />Bentonite per 94 Ili <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 />