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�Y` PauiH ,af SAN.PIOAQUIN <br />Environmental Health Department <br />- COUNTY— <br />1 <br />c4 fP', Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 12 `L 2 ( Inspector: (;r u60,117 �L CONSTRUCTION <br />Facility Address: ii -3 \ il)- LL <br />Well Address: <br />Cement 471b <br />Bas <br />Total Depth: <br />WP# <br />Thickest Thinnest <br />Well#:' Drilling Rig Type: <br />Thdest Thinnest <br />Soil Boring#: <br />2.5 5 <br />�in 2" Annular EHD Seal Verified <br />Drilling Company: <br />10 <br />1 <br />5 10 <br />Driller Onsite: <br />)u.��'i,ti <br />Screen Length <br />From: <br />Consultant: <br />a <br />Filter Pack <br />From: <br />Geologist: <br />10 20 <br />Bentonite <br />From: <br />40 <br />4 <br />Grout <br />From: <br />Public Water System <br />Onsite: <br />❑ Yes ❑No COMPLETION <br />❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes 11 No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />—wiheight <br />g —CrW-T <br />ABOVE -GROUND CHRISTY 3OX <br />COM?LETION COMPLETION <br />Ground Surface <br />grout <br />ft. <br />tt. _ <br />iK. _ SIO <br />O <br />— C <br />— o <br />stottad = <br />aocton — B <br />g-1 pad* <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: i (7� <br />Grout Material: <br />Gallons of Grout Used: VATERIALS/DEVE LO PM ENT <br />t7 a3�� Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />Slot Size: <br />❑Boring InstallationBoring Destruction Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />❑ Gravity ❑Tremie ❑Other: Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ItBags <br />Thdest Thinnest <br />"Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.535 <br />70 <br />7 <br />20 40 <br />RA <br />40 <br />80 <br />8 <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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />