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SAN.,;IOAQUIN <br />—COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 1'2 Inspector: CONSTRUCTION <br />Facility Address: S \WJt"�_ <br />Well Address: LeD Total Depth: <br />WP# ��'J� Well#: A_ Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br />Drilling Company: L-) ` � L1\ 1-Q' -- <br />E] Yes []No <br />Driller Onsite: �P�`'��� Screen Length From: To: <br />Consultant: Filter Pack From: To: <br />Geologist: a� � � M� <br />Bentonite From: To: <br />Grout From: To: <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 />❑ Yes <br />❑ Yes <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:`�� <br />Depth to Water: <br />Grout Material: 'C-�'[ <br />Gallons of Grout Used: "S cQ <br />❑Well Installation Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 'Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />1s <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 />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />40 <br />80 <br />8 <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRM-n'-sox <br />COMPLETION COMPLETION <br />Ground surtxs . + <br />grout <br />ft. <br />ft. <br />ft. <br />0 <br />-= o <br />slonad `U — c <br />sac„on �= — <br />= tx� Pack <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 />