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F, SAN:JOAQUIN Environmental Health Department <br />5_—COUNTY— <br />Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: T-L-z21nspector: <br />Facility Address: Z Y / N. �Iuta8&eu <br />Well Address: /A9 <br />WP#� 00 (12 / U Well#: Alln <br />Soil Boring#: 56 <br />S <br />Drilling Company: V. D✓, <br />Driller Onsite: P"6?4 <br />Consultant: /n "L410 <br />Geologist:_ j9.1),p4C-- <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />/ Yes <br />❑ Yes <br />❑No <br />/N0 <br />SAMPLING <br />From: <br />To: <br />Holding Temperature: <br />From: <br />To: <br />Method: <br />From: <br />To: <br />Screening Method: <br />10 20 <br />Verified Chain of Custody: <br />❑ Yes <br />❑No <br />SPOILS <br />3 <br />10 20 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />5 <br />25 so <br />Covered: <br />❑ Yes <br />❑No <br />If yes, material: <br />6 <br />17.5 35 <br />GROUTING or DESTRUCTION Total Depth: 7, <br />Depth to Water: 30 <br />Grout Material 7 L�i�tr <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes F-1 No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />ft. <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring InstallationjBoring Destruction Slot Size: <br />Bags of Cement: <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />lZaI1111 ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br /># s <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 so <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <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 />