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='�P��)'M,c°2, SAN JOAQUIN <br />�� , r-'1,'� ��� `, COUNT Y— <br />'cq�-iFoar'`P'� Greatness grows herr. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ;��Z'� -%Z Inspector: /✓qs���"` <br />Facility Address: �%O �, � r�C � `� �ti +l5 <br />Well Address: <br />WP# �. � �� ��3`s� Well#: N1w•—�- <br />Soil Boring#: <br />Drilling Company: �o�; t rcwti�,: 3 <br />Driller Onsite: ��_�` <br />Consultant: _ <br />Geologist: i��� <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 />@i7�11��1 <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes <br />❑ Yes <br />❑No <br />❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <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 />❑ Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />S°!° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />ti Bags <br />2.82 <br />Thickest <br />Thinnest <br />#Bags <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 />S <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 />8 <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 <br />COMPLETION <br />From: i o` <br />Stove Pipe <br />CYYes ❑No <br />To: +'i' ���� ,•ray i> <br />9 �i y�"'tI`t <br />To: �� _ /' <br />t'y� <br />❑Christie Box ✓ <br />. . <br />i ii � <br />�� a�`j!\ <br />�� \�� <br />:. - . <br />�- :. <br />.. <br />� .. <br />`V <br />n. <br />,r <br />r� � _ <br />ti•• - <br />.,,. <br />>�: _ <br />sbttQd Y = — ' <br />wc9on �'v� _ <br />:�: _ <br />}: <br />�:�::: _ <br />MATERIALS/DEVELOPMENT <br />Casing Type: �f� ��� 4C� <br />Blank 'Z3' Feet Screen ►pr Feet <br />Slot Size: � �'Z � <br />Bags of Cement: �► �� S� �tLi � �� �� � � �`� <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite:. ��+� }-�., � � �kr'�s _�� <br />Filter Pack Type/Size: � _3 .So-� <br />Type of Method: ��� <br />BentonitelCement Mix <br />3% Mix <br />S°!° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite <br />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 />