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SAN JOAQUIN <br />N Environmental Health Department <br />" —COUNTY <br />'O,caoa'P' Greatness grov+s her,, <br />Monitoring Well/Soil Boring Inspection Report <br />Date: i LL Inspector: <br />Facility Address: CL0 L"Vy"'A <br />Well Address: oa' <br />WP# AyA1 _ Well#: <br />Soil Boring#: r lY7, -rz-v ([)T 5 <br />Drilling Company: <-mak <br />Driller Onsite: �L"' <br />Consultant: �� .L✓`i�y� <br />Geologist:" <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 />Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />L-IA\�L1P301\re <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 />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 'ty✓ <br />Depth to Water: Z� <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation�oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ,6Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />qallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ags <br />Thickest Thinnest <br />VBags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <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 />1 i.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />6 <br />❑ Yes 1-1 No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND C7 �i S7Y 30 X <br />a AP LMO N COMPLETION <br />Ground svtx+ <br />Grout <br />ft. <br />ft. <br />ft. _ <br />�.Y. <br />_ o <br />abttQd = � <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 2.821 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 />