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11"---�` SAN 1UAQUIN <br />—COU NTY <br />:��,Foaa4 Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 171z3M27-inspector: /V'�h er�-^ <br />Facility Address: 2 5 /��✓�`+"t <br />Well Address: <br />WP# W y3 Well#: <br />Soil Boring#: '2- F- LZ - 01 <br />Drilling Company: GnP,� <br />Driller Onsite: "t O <br />Consultant: ( fey <br />Geologist: S11 le <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 />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />r <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: Z <br />Grout Material: 31vs c�.YtP4, <br />Gallons of Grout Used: q 5y ([eKS <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout_/❑Over Drill <br />❑ Gravity LJTremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallill ons <br />Cement 941b <br />Ba s <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />4Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <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 />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From <br />From <br />From <br />From <br />❑ Stove Pipe <br />i res ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHMM-Box <br />COMPLETION COMPLETION <br />Ground Surfa" <br />grout <br />ft. <br />ft. <br />tt. <br />= o <br />_ a <br />stottad `' 6 <br />sacdon12 <br />— .9 <br />tt.I F= tt. <br />MATERIALS/DEVELOPMENT <br />Casing Type: 11 <br />Blank eet 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 X 1.41 2.47 <br />Bentonite per 9411b 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 />