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SAN JUAQUIN <br />'_•=;' ---COUNTY <br />9crFoa�: Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: W2 L Inspector: ItIlf-se-f.— <br />Facility Address: /2 <br />Well Address: <br />WP# OCA `%3 "'-f Well#: <br />Soil Boring#: /,., -L/ 3 _ <br />Drilling Company: /, *t�lih'��C <br />Driller Onsite:r-ln- <br />Consultant: al ola Zle SzL�� <br />Geologist: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: 3c)� <br />Depth to Water: 7-01 <br />Grout Material: <br />Gallons of Grout Used: ZJCJci Z <br />❑Well Installation❑Well Destruction <br />❑Boring Installation L1/Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />El Gravity �remie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />eall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <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 1 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHStS TY4= <br />COWPLETION cOMPLEncN <br />Ground Sumacs <br />01 grout <br />ft. <br />- — e <br />— o <br />stottxf = <br />asc�on " — <br />sa �+�+ P. -.k <br />tt. `= = n- <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 1.411 2.47 <br />Bentonite per 94 Ib 2.821 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 />