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SANIOAQUIN <br />"—COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:'\ �`J 'W'2:3 nspector: _ � CONSTRUCTION <br />Facility Address: I K b ()U <br />Well Address: r� K (-A V,— t_�jK , Total Depth: <br />WP# U( '4"�21'?_) Well#: 0 12� Drilling Rig Type: <br />Soil Boring#: S Min 2" Annular EHD Seal Verified: <br />Drilling Company: <br />❑ Yes ❑ No <br />Driller Onsite: V\- t_� <br />Screen Length <br />From: <br />To: <br />Consultant: �> I�VPcC,� 1� �1(� <br />Filter Pack <br />From: <br />To: <br />Geologist: 'LIA,h <br />Bentonite <br />From: <br />To: <br />1 <br />Grout <br />From: <br />To: <br />5 <br />10 <br />2 <br />10 <br />Public Water System Onsite: Yes El No <br />COMPLETION <br />❑ Stove Pipe <br />[]Christie Box <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />❑ Yes l No <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes 11 No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water: <br />Grout Material: T <br />Gallons of Grout Used:X00 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation /Boring Destruction <br />nnFTunn I ICFn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bag's <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />5 <br />25 <br />50 <br />5 <br />15 <br />17.5 <br />0 <br />31F <br />6 <br />7 <br />30 <br />60 <br />6 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />it. <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 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 />