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SAN JOAQUIN <br />couNTY-- <br />\` Greatness grows here. <br />Environmental Health Department <br />Monitoring well/ oil Boring Inspection Report <br />Date: Inspector: <br />Facility Add ess:� <br />Well Address: <br />WP# OOLk <br />Soil Boring#: �, \ -� <br />Drilling Company: Qtl u c, <br />Driller Onsltp <br />Consultant <br />Geologist: <br />Well#: <br />1. CONSTRUCTION <br />I k(NL <br />Total Depth: <br />Drilling Rig Type: <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: ❑Yes ❑No <br />@T7�1Ry <br />Contamination Noted: ❑Yes ❑ No <br />If yes, spoils storage Location: <br />Covered: <br />El Yes <br />❑No <br />If yes, material: 1 <br />GROUTING or DESTRUCTION Total Depth: 10-L� %---- <br />Depth to Water: LrN <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />.jGravity <br />/t2 <br />Tremie <br />❑Other: <br />Water <br />gallons <br />Cement 471t? <br />Bags <br />+,Vater <br />gallons <br />Cernent 941b <br />Ba s <br />Thickest <br />Thinnest <br />I #BaM <br />PM <br />Thickest <br />Thinnest <br />#Bags <br />2.5 <br />5 <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 />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 />40 <br />s0 <br />3 <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />casing <br />height <br />ABC]YE-G F3 G�UND CNA SSiY-r30X <br />GOIVPLET1CN COt.iPLE; lON <br />Gmind Surf 10* <br />grout <br />fto <br />ft_ <br />slotted � _ ' <br />s*cton '— <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 />a <br />q <br />m <br />C <br />c <br />Screen <br />Feet <br />Bentonitel0ement 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 � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <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 />a <br />q <br />m <br />C <br />c <br />Screen <br />Feet <br />Bentonitel0ement 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 � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />