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SAN JOAQUIN Environmental Health Department <br />COUNTY— <br />"a Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: rwr� <br />Facility Address: -t-jo—lk �rr �✓ ,vv� yjls <br />Well Address: <br />Soil Boring#: j <br />Drilling Company: <br />Driller Onsite: _ <br />Consultant: <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 />Well#: <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 .0N10 COMPLETION ❑ Stove Pipe <br />❑ Yes <br />❑ Yes E] No <br />Contamination Noted: ❑ Yes >o <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 172, t <br />Grout Material <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />ft. <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation,2Boring Destruction <br />nerTunn 1 Irma <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ?re mie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />!l Bags <br />Thickest Thinnest <br />it Bags <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 />2 <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 />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 />