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SAN JUAUUIN <br />Ll �_—COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 14 -moi Inspector: /�l'�'ts•. <br />Facility Address: 2-3 Z w <br />Well Address: <br />WP#_Q0'/,3 Well#: <br />Soil Boring#: �/, Z, '3 <br />Drilling Company: A<%ire <br />Driller Onsite: �Tz, %- e <br />Consultant: %v 7lw <br />Geologist: As r, e <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: S-?, t, /01, to f <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />IF� f <br />height <br />ABOVE -GROUND CHRIM-Box <br />COMPLETION COMPLETION <br />Ground Suiacs <br />grout <br />ft. <br />ft. <br />O <br />= o <br />_ o <br />stoned <br />on <br />gravel pacts <br />Depth to Water: n- <br />- <br />`= —ft. <br />Grout Material: NIrl'-f C_.z.apct <br />k(lcr.•�� /oSr/c /�(�s.r(�ATERIALS/DEVELOPMENT <br />Gallons of Grout Used: <br />Casing Type: <br />❑Well Installation ❑Well Destruction Bljank Feet <br />N( <br />�/{,/rz/�%r�APot Size: <br />❑Boring Installation C'JBoring Destruction , <br />yew Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />El Pressure Grout ❑Over Drill Type/Brand of Bentonite: _ <br />LSI <br />��,�� �L Filter Pack Type/Size: <br />L�Glravity, remie ❑Other: Type of Method: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />9Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <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 />