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SAN_JUAQUIN <br />[[ �� —COUNTY— <br />N <br />Greotness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Yl* (2Z' Inspector: /�j J45Oer'^ <br />Facility Address: %(2 Sr 13 a.ti4elr S <br />Well Address: <br />WP# cap y36 $ <- well#: <br />Soil Boring#: 9 1, Z, 3 <br />Drilling Company: T</rte'dO- <br />Driller Onsite: 1/."%t-te- C <br />Consultant: Z Pi/a.es— <br />Geologist: Avjej *') <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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />[]Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRISTY43OX <br />COMPLETION COMPLE 1CN <br />Ground surf=* <br />grout <br />n. <br />ft. <br />ft. <br />o <br />i' _ . = gnv91 pacsc <br />GROUTING or DESTRUCTION Total Depth: ZSR a-5-5'a� <br />Depth to Water: 1-71 n• <br />Grout Material: ) 4, f- r,e,„o• <br />Gallons of Grout Used: 5i� �a .54 /10-4 MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation ❑Boring Destruction 6 1 -, <br />METHOD USED <br />El Pressure Groutt❑Over Drill <br />El Gravity L/Tremie ❑Other: <br />// <br />y ,S'tG Slot Size: <br />/+d'z Bags of Cement: <br />2/ 133 . (v "ffo Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gall ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />9Bags <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 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 1 40 <br />8 <br />40 <br />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 />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 />