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SAN 0AQUIN <br />COUNTY--- <br />Greatness grows here. <br />Environmental Health Department <br />Lj <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 611y I Inspector: & vlami.v — <br />CONSTRUCTION <br />Water <br />gallons <br />FacilityAddress: <br />Rd <br />Thickest Thinnest <br />ttBags <br />Well Ad ress: <br />Bags <br />Total Depth: <br />1 <br />WP# 00 3 41 <br />Well#: <br />Drilling Rig Type: <br />5 10 <br />Soil Boring#: T33 <br />Drilling Company: &(� <br />Min 2" Annular EHD <br />17,i I I V1 ON 60 -IVY—,Screen <br />Seal Verified <br />Driller Onsite: C,cQ�til <br />✓� ril <br />Length <br />From: <br />Consultant: qqq Lklg <br />it i.Pe_y-i v-7 <br />Filter Pack <br />From: <br />Geologist: E�/�L <br />40 <br />Bentonite <br />From: <br />5 <br />25 <br />Grout <br />From: <br />Public Water System Onsite: <br />❑ Yes ❑No <br />COMPLETION <br />❑ Stove Pipe <br />Domestic Well Onsite <br />If yes, location and distance: <br />LWA�Mil>11111lilre <br />❑ Yes ❑No <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes E] No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water: ';:),-oGrout Material: kkear¢ <br />Gallons of Grout Used: -55 <br />❑Well Installation ❑Well Destruction <br />El Boring Installation V11toring Destruction <br />nnl`TNnn t IcFn <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Y9remie ❑Other: <br />water <br />gallons <br />Cement 471b <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />If hnl� <br />�if -�orh 13r T <br />❑ Yes EJ No <br />To: <br />To: <br />To: <br />To: <br />❑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 />ft. <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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />