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JANiJUAQUIIN <br />- COUNTY— <br />, <br />neatness grows 7efP <br />Environmental Health Department <br />Monitorin Well/Soil Boring Inspection Report <br />Date:q w -Inspector: <br />CONSTRUCTION <br />Facility Address: 2A -10% �_ �� _ <br />t✓ye„ <br />Well Address: A.101 <br />Total Depth: <br />WP# ItiI f lM y I -Az -L" Well#: <br />Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />S7Ws–Z" �� �o <br />Drilling Company: k S� <br />Driller Onsite: kA tJ A <br />Screen Length From: To: <br />Consultant: <br />Filter Pack From: To: <br />Geologist: _�� <br />Bentonite From: To: <br />2 <br />Grout From: To: <br />Public Water System Onsite: �s ❑No <br />COMPLETION El Stove Pipe ❑Christie Box <br />Domestic Well Onsite: Yes ❑No <br />casing <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 />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: 3 G <br />Depth to Water: /IIIA <br />Grout Material: A/ Grp f <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation /Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Y(sravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <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 />4D <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 />height <br />AWVE-dFICUND CHASSTY 30X <br />COWLETION COMPL.ETIO.N <br />Ground sLUlaC2 <br />grout <br />tt. <br />ft. _ <br />.o <br />'11d — — <br />sac5on = — <br />; _ Q-4 rack <br />y <br />=r = <br />I F <br />MATERIALS/ D EVE LO PM 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 />Benton ite]Ce ment 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 />