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,' ��"'' <br />�'\ 7 = � V <br />r _ �y- <br />� N G cm,.. <'y <br />����'�CrFoa���'; <br />SAN JUA[�UIN <br />--COU NTY - <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �/��/�� Inspector: J�y45�"w• <br />Facility Address: It�.3r� �' ��r�t � <br />Well Address: <br />WP# op7?j���% Well#: <br />Soil Boring#:—�$/..s0 �8z�0 %''�3��� <br />Drilling Company: �QdG <br />Driller Onsite: <br />Consultant: <br />Geologist: a �'` <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 ❑ No <br />❑ Yes ❑ No <br />❑Yes <br />❑Yes <br />❑Yes <br />❑No <br />❑No <br />❑No <br />If yes, material: <br />i <br />GROUTING or DESTRUCTION Total Depth: �f <br />Depth to Water: � �✓`�y" <br />Grout Material: „/t�� �e�P <br />Gallons of Grout Used: S� -r' �' �5g�ld�r <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation L�'Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Ltd"Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />S°!° Mix <br />Water <br />allons <br />Cement 941b <br />Bads <br />Thickest <br />Thinnest <br />#Bags <br />2.82 <br />Thickest <br />Thinnest <br />#3 Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />�- <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />y.: <br />15 <br />30 <br />3 <br />a -z <br />4 <br />20 <br />40 <br />4 <br />10 <br />20 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />30 <br />60 <br />6 <br />15 <br />30 <br />6 <br />35 <br />70 <br />7 <br />17.5 <br />35 <br />7 <br />40 <br />80 <br />8 <br />ZO <br />40 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />. 'w � <br />casing <br />height <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />�- :. - <br />.. • <br />� � .. <br />//. <br />`u � <br />.._ft. <br />3°�° Mix <br />S°!° Mix <br />Bentonite per 47 ib <br />1.41 <br />2.47 <br />Bentonite <br />per �4 Ib <br />2.82 <br />4.7 <br />=gid. <br />�- <br />y.: <br />a -z <br />;-: <br />_ <br />.K'r <br />yy �� <br />�� <br />s�►f.� <br />'1s <br />�� <br />� `�� <br />aeon <br />_ <br />'-- <br />-. <br />f: <br />:�>: <br />_ <br />.� <br />— <br />. <br />�::� <br />_ <br />�,. <br />=.�' <br />-'� <br />�ft. <br />—' <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 <br />tt. <br />Feet <br />BentonitefOement Mix <br />3°�° Mix <br />S°!° Mix <br />Bentonite per 47 ib <br />1.41 <br />2.47 <br />Bentonite <br />per �4 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />