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SAN JOAQUIN <br />Environmental Health Department <br />— COUNTY" <br />G1: JMess grows he <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: &t` %L,.0 <br />Facility Address: l D ,tiC D (v1 <br />Well Address: _ �� .�1� l L•� CVU,-j­ <br />WP# 4A-� A„i q Well#: <br />Soil Boring#:T� tT��>� <br />Drilling Company: <br />Driller Onsite: V OLv 'c <br />Consultant: �rLoS�iw ti <br />Geologist: o <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />LWAI AINSIAre <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 0 N <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: C) <br />Depth to Water: <br />Grout Material: &&A— <br />?Ll <br />Gallons of Grout Used: =V <br />❑Well Installation ❑Well Destruction <br />El Boring Installation [oring Destruction <br />k Jr!brer 1§T1Nd.1 <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 4Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />«Bags <br />Thickest Thinnest <br />:t Bags <br />2.5 <br />5 <br />5 <br />10 <br />1 <br />5 <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 />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: p <br />Drilling Rig Type: G� `'i' �A'3 -17 <br />Min 2” Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />CYIMPI FTIMU <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />MiVE-GROUND GFS± STY 30X <br />CDVPLE ION CCt.iPLETICN <br />Ground st;rlxs <br />grout <br />ft. <br />ft. <br />n. <br />— a <br />= m <br />— o <br />atottad <br />a 'on <br />ft. IF <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 />