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SAN-JOAQUIN <br />—COUNTY— <br />: Greatness grows here. <br />Environmental Health Department <br />Monitori Well/Soil Boring Inspection Report <br />Date: '�, Inspector: ACONSTRUCTION <br />Facility Address: 1 Cj L -K <br />Well Address: / A Total Depth: <br />WP# 1 o Well#: AL) d9 Drilling Rig Type: <br />Soil Boring#: ! T - ) - 3 Min 2" Annular EHD Seal Verified: <br />Drilling Company: k AL. --2 <br />❑ Yes ❑ No <br />Driller Onsite: IN Screen Length From: To: <br />Consultant: '�c}� �RSso` <br />Filter Pack From: To: <br />Geologist: S FQ17 <br />Bentonite From: To: <br />1 Grout From: To: <br />�I <br />No <br />�INo <br />Public Water System Onsite: ❑ Yes <br />Domestic Well Onsite: ❑ Yes <br />If yes, location and distance: <br />CDIVIPI li\ir <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: O <br />Depth to Water: -Q R <br />Grout Material: rJ_�vP�t <br />Gallons of Grout Used: w I S <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation C/Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />0 Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallill ons <br />Cement 941b <br />Bays <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />NBags <br />2.5 <br />1 <br />5 <br />10 <br />1 <br />5 <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 />COMPLETION ❑ Stove Pipe ❑Christie Box <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 />