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SAN 10AQUIN Environmental Health Department <br />—COUNTY— <br />Greotness gror s here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ✓ (ZZ Inspector: <br />Facility Address: ouAW, Or. K <br />Well Address: <br />wP# OoV,3 9-->s . W II#: <br />Soil Boring#: V 1 F— U —0 <br />Drilling Company: (� <br />Driller Onsite: <br />Consultant: '1i <br />Geologist: eu-e <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 />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 3v <br />Grout Material: ex- Ce-/` <br />Gallons of Grout Used:��,�. <br />❑Well Installation []Well Destruction <br />❑Boring Installation ring Destruction <br />METHOD USED <br />[]Pressure Grout ❑Over Drill <br />❑ Gravity ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />To: <br />Water <br />izallons <br />Cement 94 lb <br />Bags <br />TM,ke>t Thinne"t <br />2.5 5 <br />1 <br />5 <br />ThnnF>t <br />10 <br />Saes <br />1 <br />5 10 <br />2 <br />10 <br />_ <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />735 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE-{aROUND CF i1STYBOX. <br />GOMi'LET10N COMPLETION <br />Grourn SWa" <br />grout <br />ft. <br />tt. <br />ft. <br />_ — o <br />•band — B <br />ax5en <br />= 9 -VW Pads <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 />Bentonitelcernent Mix <br />Elenionii:e per 41 Ib <br />I rx" Mix <br />1.4,11 <br />Is"lam Mix <br />2.47 <br />Bentonite per 94 Ib <br />2.821 <br />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 />