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SAN 10AQUIN <br />Environmental Health Department <br />'1 <br />,_,,,t=`�'I Greotness Sro;s �terF. <br />Monitoring Well/Soil Boring If�spection Report <br />Date: L LI L1 <br />Facility Ac�dres <br />Well Address: <br />W P# QQ <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant <br />Geologist: <br />Well#: <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 />GROUTING or DESTRU� <br />Depth to Water: <br />Grout Material: �-1 <br />Gallons of Grout Used: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑Yes ❑ No <br />ON Total pepth: (�1 <br />0 <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity <br />❑Tremie <br />❑Other: <br />Water <br />allons <br />ment 471b <br />ea s <br />�°J° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />s <br />4.7 <br />Thickest <br />Thinnest <br />� Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <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 />20 <br />40 <br />8 <br />40 <br />80 <br />$ <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 <br />Grout <br />COMPLETION <br />❑ Yes ❑No <br />To: <br />To: <br />From: To: <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />J�BOYE-GROUND CNRSSTY-80X <br />GOMPL.ETlON CQMPtETION <br />c�roc,r>d sumacs .� <br />grout <br />ft. <br />ft. <br />p <br />aacion ` <br />:a- <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 />Feet <br />BentonitelGement Mix <br />3°J° Mix <br />�°J° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />