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f'`s'"�c�'-� SAN�JOAQUIN <br />"' � 'I;t. ��'—000NTY— <br />s �.-. <br />_ Greo Mess grows here. <br />Environmental Health Department <br />q Mocnit_o1ring Well/Soil Boring Inspection Report <br />Date: l 2322 Inspecto�: Jc-�1l��- CONSTRUCTION <br />Facility Address: 206 N . Su . Y S�. <br />Well Address: Total Depth: <br />WP# � 'J6 Z 3 Well#: Drilling Rig Type: <br />Soil Boring#: ci � <br />Drilling Company: (� 2V1N-+�� Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Driller Onsite: Screen Length From: To: <br />Consultant: OP rif <br />Filter Pack From: To: <br />Geologist: 1-.t)�� Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑Yes ❑No <br />Domestic Well Onsite: ❑Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Screening Method: <br />Verified Chain of Custody: ❑Yes ❑No <br />SPOILS <br />Contamination Noted: ❑Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑Yes ❑No <br />If yes, material: <br />� 1 I <br />GROUTING or DESTRUCTION Total Depth._ / �� 35 <br />Depth to Water: Q. � F <br />Grout Material: GP,h�PXL <br />Gallons of Grout Used: 'V Lf � <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation�¢oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over D(�rpi�ll �nt^� <br />❑ Gravity 'k9,Tremie i ❑Other: . <br />�--. <br />Water <br />allons <br />ent 471b <br />ea s <br />Water <br />allons <br />Cement 9414 <br />Ba <br />Thickest <br />Thinnest <br />ags <br />ThI&est <br />Thinnest <br />4Bags <br />2.5 <br />5 <br />1 <br />5 <br />30 <br />1 <br />s <br />l0 <br />2 <br />10 <br />23 <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 />9 <br />12,5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />80 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />to <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />BentonitelCement Mix <br />3 % Mix <br />5 % Mix <br />Bentonite er 47 Ib <br />1.41 <br />2.47 <br />Bentonite er 941b <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 � www.sicehd.com <br />