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SANi�,J0A0UIN <br />'—COUNTY— <br />Greciness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ei.4nspector: CONSTRUCTION <br />Facility A dress: O <br />Wz+*d6re-sTotal Depth: <br />WP# 4 3 3 Li Well#: N Drilling Rig Type: <br />Soil Boring# Jam. <br />Company: <br />MLQ2[A E�7.K Min 2" Annular EHD Seal Verified: <br />DrillingCom an i <br />❑ Yes []No <br />Driller Onsite: <br />Screen Length From: To: <br />Consultant: L Jkc.-.. Filter Pack From: To: <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />Yes <br />/❑ Yes <br />❑No <br />[ No <br />/ <br />SAMPLING <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Holding Temperature: <br />Thickest Thinnest <br />#Bags <br />Method: <br />C5 <br />1 <br />Screening Method: <br />1 <br />5 <br />Verified Chain of Custody: <br />❑ Yes <br />❑No <br />SPOILS <br />7.5 <br />15 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />20 <br />4 <br />Covered: <br />❑ Yes <br />❑No <br />if yes, material: <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water: <br />Grout Material: /V 68 T c k, -A - <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring InstallationXBoring Destruction <br />METHOD USED <br />[]Pressure Grout❑Over Drill <br />ElGravity Aremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />>7 ags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />C5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 1 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />B <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />tt <br />MATERIALS/DEVELOPMENT <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 2.82 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 />