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` SAN JOAQUIN <br />Environmental Health Department <br />1 COUNTY-- <br />4e�*.'/ Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 41 Inspector: i ' <br />Facility Address: 4 y (,✓ L-LitilL' tI <br />Well Address: E:1z1A yZU <br />WP# L Well#: _ <br />Soil Boring#:(-�— <br />Drilling Company: <br />Driller Onsite:i 1 �.k- 1-2 <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes E 1No <br />Domestic Well Onsite: ❑ Yes CJNo <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 />CONSTRUCTION <br />Total Depth: v n� <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />GROUTING or DESTRUCTION Tottal DePL' f '0� �l <br />Depth to Water: <br />Grout Material: Zvi <br />Gallons of Grout Used: ., 'Z'3 �U <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation,6Boring Destruction <br />rMr11111reri.TIL14y. <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ZTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thin est <br />:Bas <br />Thickest Thinnest <br />xBags <br />2.5 5 <br />5 10 <br />1 <br />s to <br />z <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />1Z5 35 <br />7 <br />35 70 <br />til 40 <br />8 <br />40 80 <br />8 <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 />AB.: VE -G R CUN D Gni STY -sox <br />C 0kFLETZN CCM?LEiTCN <br />Ground suix+ <br />grout <br />ft. <br />ft. <br />tt. <br />= m <br />U <br />atottvci = � <br />sac .cn <br />grivE4; X <br />MATERIALS/DEVELOPM ENT <br />Casing Type: <br />Blank Feet Screen 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 />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 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 />