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- SANJOAQUIN Environmental Health Department <br />' —COUNTY— <br />. Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: VW 152 -Inspector: CONSTRUCTION <br />Facility Address: <br />Well Address: N (^1 Total Depth: <br />WP# q Z'26Z Well#: A)-I&—Drilling Rig Type: <br />Soil Boring#: Sh .- - S(� - S Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Drilling Company: TtiGHn/LcoN-'� <br />Driller Onsite: Vw %ti. Screen Length <br />From: <br />To: <br />Consultant: Filter Pack <br />From: <br />To: <br />Geologist: J'ptL.o(i?h. Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance <br />(o S o , <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 />❑ Yes <br />L/J Yes <br />t <br />■ <br />■ Me <br />❑ Yes ❑No <br />❑ Yes ❑No <br />Covered: ❑ Yes ❑ No <br />If yes, material: III --L3I It <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: I" / 7' <br />Grout Material: N T <br />Gallons of Grout Used: t <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation VBoring Destruction <br />METHOD USED <br />El Pressure Grout ❑Over Drill <br />❑ Gravity VTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <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 />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRZTY43OX <br />COMPLETION COMPLETION <br />Ground Surface -- <br />proof <br />n. <br />ft. <br />tt. <br />= a <br />• <br />-= o <br />slotted: <br />sac9on- "— <br />_ g-vW pack <br />ft. IF=IF n <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 209 468-34201 F 209 464-0138 1 www,sicehd.com <br />