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SAN"AAQUIN <br />—COUNTY— <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /-5/U Inspector: &,L5p CK( CONSTRUCTION <br />Facility Address: d ri,Kf-VV � (-K <br />Well Address: Total Depth: <br />WP# 00 Z.' Well#: Drilling Rig Type: <br />Soil Boring#: ZF-2 I -00 Min 2" Annular EHD Seal Verified: <br />Drilling Company: G re -6w <br />❑ Yes ❑No <br />Driller Onsite: Screen Length <br />From: <br />To: <br />Consultant:" Filter Pack <br />From: <br />To: <br />Geologist: Y-rI >✓V C52 Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <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 />Covered: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes El No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: <br />i <br />GROUTING or DESTRUCTION Total Depth: U <br />Depth to Water: l U I <br />Grout Material: 'eLr e "' <br />Gallons of Grout Used: U ^ <br />❑Well Installation ❑Well Destruction <br />❑Boring Installatioro;*ring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity k rTremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />eall ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />2.5 5 <br />9Bags <br />1 <br />Thickest Thinnest <br />5 10 <br />#Bags <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 />8 <br />40 <br />80 <br />8 <br />casing <br />height <br />ABOVE -GROUND oHRmry-Box <br />OOWPLE ION comPLEn0N <br />C;rocind $uutaco <br />grout <br />ft. <br />ft. <br />0 <br />- o <br />s{ottad Z;,. <br />sscxon 9 <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/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 />