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SAN."JOAQUIN <br />COUNTY <br />Gireocnrss arct^rs here. <br />Environmental Health Department <br />Monitoring Well/ )oil Boring Inspection Report <br />Date: L0�2'� Inspector: CONSTRUCTION <br />Facility Address: 3o <br />Well Address: o kLve >I -',�` � - Total Depth: <br />WP#j b Well#: 'S� �— Drilling Rig Type: S �k%Dmoms: <br />L <br />Soil Boring#: F\ Min 2" Annular EHD Seal Verified: Yes <br />Drilling Company: �fl�� C �Z Q.'��- OQ.�L�- �' <br />Screen Length From: • S To: <br />Driller Onsite: Njo Q.N� / 1 � <br />Consultant:c�� ��}L�7�µ Filter Pack From: l 1., To: SS.S S3 <br />Bentonite From: !j1,. S To:. , <br />Geologist: 'Vi7` f <br />Grout From: SO . S To:.w a S <br />-�-�� <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 0 N <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />❑ Yes ONO <br />S*Cuon <br />❑ Yes ❑No I <br />GROUTING or DESTRUCTION Total Depth: 41 <br />Depth to Water: � moo. _,:_ <br />Grout Material: !U -iP�`c C,�s Vorg\ . <br />Gallons of Grout Used: � 'Lo <br />Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Li Gravity <br />C�Tremie <br />❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />S°!° Mix <br />+Nater <br />Qallons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />ttBags <br />r <br />Thickest <br />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 />15 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />D <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />MATERIALS/DEVELOPMENT <br />Casing Ty e: <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�Q_ Feet <br />3°�° Mix <br />S°!° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />r <br />az <br />- <br />F <br />MATERIALS/DEVELOPMENT <br />Casing Ty e: <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�Q_ Feet <br />Bentonite}Gement Mix <br />3°�° Mix <br />S°!° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />�I <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />