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SAN.kJOAQUIN <br />—COUNTY— <br />C, <br />COUNTY— <br />' [� <br />C71-eatne$s groves IIEfP <br />Environmental Health Department <br />/ c�/7 I ✓ Monci/toningW/ell/Soil Boring Inspection Report <br />Date: ) -1119 `� Inspector: lkh/t�/l'�� CONSTRUCTION <br />Facility Address: e& y' )o *Z3 "7'7Gty I "1Cys 4'2S'Toc-ltrt7,-z <br />Well Addr ss: Total Depth: <br />WP# 01)z U L Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: (V�4fu� Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑ No <br />Driller Onsite: Screen Length From: To: <br />Consultant: % �jevi�C Filter Pack From: To: <br />Geologist: �-V,�- <br />Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <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 />tpnn c <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes 11 No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: DU <br />Depth to Water: C-kc0C­ti-*eVe; <br />Grout Material: T e —T C e v'-O-,� <br />Gallons of Grout Used: --- Z.];.11G <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation kB�oring Destruction <br />METHOD USED C f <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �emie ❑Other: <br />Water <br />allons <br />5% Mix <br />2.47 <br />Cement 471b <br />B <br />Water <br />R21111 ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br /># Bags <br />Thickest Thinnest <br />5 <br />10 <br /># Bags <br />1 <br />2.5 5 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 />10 <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 />PON—M—EN9i <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 <br />Bentonite per 47 Ib 1.41 <br />5% Mix <br />2.47 <br />Bentonite per 94 Ib 2.82 <br />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 />