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SAN JOAQUIN Environmental Health Department <br />Lint COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date. <br />v-IFacility Address: <br />Well Address: - <br />WP#—� <br />Soil Boring#. <br />Drilling Company: <br />Driller Onsite: G <br />Consultant: <br />Geologist: <br />Insr,ector: <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 DESTRUi <br />Depth to Water: '2S <br />Grout Material.IC;ti <br />Gallons of Grout Used. <br />❑ Yes ❑No <br />❑Yes <br />❑ Yes <br />❑Yes <br />Total Depth: �� <br />❑Well Installation ❑Well Destruction <br />:]Boring Installation Moring Destruction <br />METHOD USED <br />❑Pressure Grouter❑Over Drill <br />.jGravity emie_ Luther. <br />Water Cem nt 471b Water Cement 941b <br />allons Bags <br />❑No <br />❑ <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type, <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: To: <br />From: To. <br />From: To: <br />From: To. <br />❑ Stove Pipe ❑Christie Box <br />9a 16C <br />❑No <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 />Bentonite/Cement Mix <br />3% Mix <br />5% Mix <br />allons <br />Ba s <br />Thickest <br />Thinnest <br />2.82 <br />4.7 <br />Thickest <br />Thinnest <br />it 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 />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />35 <br />70 <br />7 <br />17.5 <br />35 <br />7 <br />40 <br />80 <br />8 <br />20 <br />1 40 <br />8 <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 />Bentonite/Cement 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 I T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />