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SANsJOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here. <br /> c1 <br /> Monitoring W 1,/-�S ring Inspection Report <br /> Date: µ 9 /2ot0lnspector: MINI STRUCTION / $CRAi <br /> Facility Address: 6 <br /> Total Depth: <br /> Well Address: Drilling Rig Type: S�11L <br /> WP# D D Well#: <br /> Soil Boring#: ?- �`R Min 2"Annular EHD Seal Verified: ❑Yes ONO <br /> Drilling Company: lS Screen Length From: To <br /> Driller Onsite: 11DS Filter Pack From: To: <br /> Consultant: �' ��h Bentonite From: To <br /> Geologist: Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic WellOnsite: ❑Yes ONO -� casing <br /> height <br /> If yes,location and distance: <br /> _� <br /> SAMPLING ABOVE-dao D C11MM-BOX <br /> CONPLETION GOMPLEnON <br /> Holding Temperature: cirotlndsult -r---^ <br /> Method: grout <br /> Screening Method: ft. <br /> Verified Chain of Custody: ❑Yes ONO n• <br /> _.n. <br /> SPOILS <br /> a — ° <br /> Contamination Noted: ❑ Yes ONO r <br /> If yes,spoils storage Location: .btt°d <br /> a*c0on <br /> Covered: ❑Yes ONO = gm <br /> mac°* <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: IR5.3� tt. <br /> Depth to Water: <br /> Grout Material: NP of Y✓U° MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction <br /> Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring installationIff'oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity �Tremi ❑Other: <br /> Type of Method: <br /> Water cement 471b Water cement 941b <br /> allons gas allons gas _ <br /> Thickest Thinnest ggagz _Bentoniteleement Mix 3%Mix 5%Mix <br /> Thickest Thinnest ea _ Bentonite per 41 Ib 1.41 2.47 _ <br /> 2.5 s 1 s to 10 n Bentonite per 941b 2.82 4.7 _ <br /> . 10 7 is 30 3 <br /> 10 15 3 <br /> 10 4 20 40 4 <br /> s <br /> 12.5 45 s 75 50 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 0 4' so e 10/16/2017 <br /> L1b bards w( ISo9AI t� <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.co <br />