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SAN JOAQUIN Environmental Health Department <br />—COUNTY— <br />Greatness grows here - <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 1Z zZ Inspector: <br />Facility Address: Aiy— "rk L' ->1`y <br />Well Address: <br />WP# A L 2I Well#: <br />Soil Boring#: (3 1 <br />Drilling Company: C,616r-c& <br />Driller Onsite: F5 jL4-" <br />Consultant: <br />Geologist:k <br />Public Water System Onsite: ❑ Yes ,�Klo <br />Domestic Well Onsite: ❑ Yes TI—No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑ No <br />SPOILS <br />Contamination Noted: ❑ Yes XI—No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: i0 <br />Depth to Water: V� <br />Grout Material:���Ct <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />gallons <br />From: <br />Cement 47 lb <br />Bas <br />water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Th' <br />t <br />t s <br />Thickest Thinnest <br />4 Bags <br />2.5 <br />5 ., <br />5 10 <br />1 <br />s <br />0 <br />2 <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 <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 />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑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 />WTcasing <br />height <br />ABOVE -GROUND Cr RLM-Sox <br />COMPLETION COMPt.E71cN <br />Ground Surra" <br />grout <br />ft. <br />tt. _ <br />_ a <br />alottad <br />sac�on <br />gravol pack <br />r _ <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 />