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" SAN JOAQUIN <br />Q Environmental Health Department <br />COUNTY— <br />�vO"P Greatness grows here. <br />Mtoonitoringg\Well/Soil Boring Inspection Report <br />Date: O' 1 Inspector:13 CONSTRUCTION <br />I <br />Facility Address: <br />Well Adddree�ss�� i j�, <br />)03Y <br />WP# LGWell#: <br />Soil Boring#: <br />Drilling Company: WaR CQ <br />Driller Onsite: Rc9b2T <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes No <br />Domestic Well Onsite: ❑ Yes Ao <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: I ❑ Yes El No <br />SPOILS <br />Contamination Noted <br />If yes, spoils storag <br />Covered: ,fj <br />If yes, material: <br />Location: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: flj2g2t Cefnent <br />Gallons of Grout Used: ^r42D — (oS 00 1 P191 <br />❑Well Installation ❑Well Destru!tTZSn <br />**ring Installation ❑Boring Destruction <br />MFTWnn I ICFn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie S i)ther: <br />Water <br />gall] s <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />4Bags <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 />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />5 <br />25 50 <br />5 <br />15 <br />3 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />35 70 <br />7 <br />20 <br />40 <br />8 1 <br />40 80 <br />8 <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular/Fm: <br />erified: ❑ Yes ❑No <br />Screen Length To: <br />Filter Pack To: <br />Bentonite To: <br />Grout To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />ft. <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 />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 <br />10/16/2017 <br />www.sicehd.com <br />