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SAN�JOAQUIN <br />' Environmental Health Department <br />it �, '. <br />_ —COUNTY— <br />°StrFb��`•P+ Greotness groves here <br />Monitoring Well/Soil Boring Inspection Report <br />SI�S� %GKN <br />Cement 471b <br />Bags <br />Date:Inspector: <br />Facility Address: <br />CONSTRUCTION <br />a t^. <br />`6S <br />_ <br />Depth to Water: n, ej&kco <br />Well Address: <br />Total Depth: <br />WP# 00 � Ij 0Well#: <br />Drilling Rig Type: <br />Soil Boring#: —3 —1 <br />Gallons of Grout Used: 9�- <br />Drilling Company: j d (�-c u v. <br />Min 2" Annular EHD Seal Verified: El Yes ❑No <br />Driller Onsite: <br />Screen Length From: To: <br />Consultant: Te Y Yt.- c -a <br />Filter Pack From: To: <br />Geologist: -}i'- L <br />Bentonite From: To: <br />3 <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes El No <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes []No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody <br />cpnn c <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />If yes, material: <br />Cement 471b <br />Bags <br />GROUTING or DESTRUCTION Total Depth: 1 _9 <br />�S�/) ��� <br />`6S <br />_ <br />Depth to Water: n, ej&kco <br />Thickest Thinnest <br />At Bags <br />Grout Material: 2 i,Pn <br />5 <br />1 <br />Gallons of Grout Used: 9�- <br />1 <br />ATERIALS DEVELOPMENT <br />asing Type: <br />[]Well Installation ❑Well Destruction <br />2 <br />Blank Feet <br />El Boring Installation El Boring Destruction <br />7.5 <br />Slot Size: <br />iz <br />3 <br />15 30 <br />gags Cement: <br />METHOD USED <br />20 <br />Bags Sand/Gravel: <br />20 40 <br />4 <br />Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill <br />5 <br />Filter Pack Type/Size: <br />>�nravity 21�remie ❑Other: <br />15 <br />Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />Rall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />riBags <br />Thickest Thinnest <br />At Bags <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 />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 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 />r <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 />