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SAN. JOAQUIN <br />l <br />--COUNTY----Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: t (t Inspector: e C t CONSTRUCTION <br />Facility Address: k 3 J SZ �' O,'k <br />Well Address: Total Depth: <br />WP# A'5k"G7;! Well#: Drilling Rig Type: <br />Soil Boring#: f7t h5")_ I ' <br />�� (,vac5 Min 2 Annular EHD Seal Verified: <br />Drilling Company: <br />❑ Yes []No <br />Driller Onsite: _k, do,Screen Length <br />From: <br />To: <br />Consultant: L E` Filter Pack <br />From: <br />To: <br />Geologist: wt� 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 />CAIVIPI Mir, <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 �2No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes Flo <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />If yes, material: Ql�t 153 by <br />i <br />GROUTING or DESTRUCTION Total Depth: W j 0j t7 I i <br />Depth to Water: ihiW-k <br />Grout Material: o)L0+ <br />Gallons of Grout Used: ''V 60 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation goring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />7Gravity ❑Tremie []Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />IS <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />20 40 <br />4 <br />12.5 <br />25 <br />25 50 <br />5 <br />15 <br />30E <br />57d <br />30 60 <br />6 <br />17.5 <br />35 <br />35 70 <br />7 <br />20 <br />40 <br />40 80 <br />8 <br />casing <br />height <br />ABOVE -GROUND CHRISTY4= <br />COM?LETION COMPLETION <br />Ground surface <br />grout <br />ft. <br />ft. <br />ft. <br />'= _ <br />w <br />_ <br />— o <br />abtted = c <br />eecdon <br />gavel pa K <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 3% 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 />