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SANJOAQUIN <br />t —COUNTY— <br />Environmental H0a0th Department <br />Monitoring Weli/Soil Boring Inspection Report <br />Date: �_ Inspector: <br />Facility Address: i Z� /E �ar,,r L jL, <br />Well Address: <br />WP# t2a!tL!! Weil#: <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: M -- <br />Consultant: <br />Geologist: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />❑ Yes <br />❑No <br />❑No <br />SAMPLING <br />Gement 94 lb <br />Bus <br />Thickest Thinnest <br />Holding Temperature: <br />Thickest Thinnest <br />ilBags <br />Method: <br />5 <br />1 <br />Screening Method: <br />1 <br />5 <br />Verified Chain of Custody: <br />❑ Yes <br />El No <br />SPOILS <br />7.5 <br />15 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />20 <br />4 <br />Covered: <br />❑ Yes <br />❑No <br />If yes, materia I: <br />5 <br />'25 50 <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: I"L <br />Grout Material: _j6X4L_A- q&m„4/A <br />Gallons of Grout Used: 9. lb. ii -A& , . <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation NKcring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />C�YGravity G7,6emie ' ❑Other: <br />Water <br />gallons <br />I <br />Cement 4711 <br />s <br />Water <br />alions <br />Gement 94 lb <br />Bus <br />Thickest Thinnest <br />k Bags <br />Thickest Thinnest <br />ilBags <br />2,5 <br />5 <br />1 <br />5 10 <br />1 <br />5 <br />10 <br />2 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />1s 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />q <br />12.5 <br />25 <br />5 <br />'25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />5 <br />17.5 <br />35 <br />7 <br />3s 70 <br />7 <br />20 <br />40 <br />B <br />L 40 1 80 <br />@ <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: — <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: A To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <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 Feet <br />BentvnitefGement Mliix 3% Mix 5% Mix, <br />Bentonite per 47 Ib 1.41 2,47 <br />Bentonite per 94 Ib 2.82 4,7 <br />10/16/2017 <br />1868 E. Hazelton Avenue i Stockton, California 95205 1 'f 209 468-34201 F 209 464-0138 1 www,sicehd_com <br />