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SAN JOAQUIN <br />�� , <br />COUNTY <br />',��,,.��;�:' Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Z'�.�� � 3 Inspector: ��E� <br />Facility Address: ; �L��� '� �'<«',� i�,�t� <br />Well Address: <br />WP# r�C� yt �l ?�� Well#: z�,�-Z <br />Soil Boring#: <br />Drilling Company: fD�t �c-�,�i3 <br />Driller Onsite: ,�'�? f'� <br />Consultant: . <br />Geologist: �,� <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 />f yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTIO <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑Yes <br />Total Depth: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />❑No <br />vvater <br />allons <br />Cement 471b <br />Bags <br />5% Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />4.7 <br />Thickest <br />Thinnest <br />tteags <br />2.5 <br />5 <br />1 <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 />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />CONSTRUCTION <br />Total Depth: � `i <br />Drilling Rig Type: _ <br />�r� � <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: 1�3� <br />Filter Pack From: �� � <br />Bentonite <br />Grout <br />COMPLETION <br />From: Zz i <br />From: 'z D t <br />ABOVE -GROUND <br />COMPLETION <br />❑ Stove Pipe <br />casing <br />height <br />I� Yes <br />To: Z �, <br />To: ZZ <br />To : �' <br />❑No <br />n{ 6 /�✓ <br />err �-�" <br />�Vi <br />To: Z <br />I�Christie Box <br />procrt <br />Z�� ft. <br />Z3 ft. a � � n. <br />:r�' _ <br />::¢: — <br />��:� _ <br />,. _. <br />slottad y '— . <br />soon =''� '— <br />:�: _ <br />�s: <br />��>;� <br />��� _ <br />�� <br />�'� n, <br />MATERIALS/DEVELOPMENT <br />Casing Type: /�V'� � �� �/v <br />Blank y3 Feet Screen � Feet <br />Slot Size: ���-� <br />Bags of Cement: � /���,� <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: �' i <br />Type of Method: "i�'c��.:Y <br />BentonitefOement Mix <br />3% Mix <br />5% 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 />