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$QNJOQQUIN Environmental Health Department <br />COUNTY <br />Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Zinspector: CONSTRUCTION <br />MC�z <br />Facility Address: <br />Well Address: i Total Depth: <br />WP# O©_Well#: Drilling Rig Type: <br />Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes 11 No <br />Drilling Company: <br />Driller Onsite: Screen Length From: To: <br />Consultant: %Y% � <br />Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe El 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: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />-- ------GROUTING-or-DESTRUCTION Total Depth:j��--- ---- <br />Depth to Water: <br />Grout Material: _ e,,. _ Q <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation RjBoring Destruction <br />METHOD USED <br />❑Pressure Grout []Over Drill <br />COGravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />izallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />4 Bags <br />Thickest Thinnest <br />4 BBgi <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 <br />30 <br />60 <br />6 <br />17.5 35 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />casing <br />height <br />Al _qw-T <br />AWVE-GROUND CHFILS Y -BOX <br />COMPLETION COMPLETION <br />Ground Surtaes <br />tZll <br />prlocrt <br />n. <br />= e <br />slotted = E <br />seCion <br />_ 9-01 Pack <br />Tic <br />w 1\. <br />MATERIALVDEVELOPM ENT <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 />