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"`' , SAN JOAQUIN <br />Environmer Health Department <br />—COUNTY— <br />°j., Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ) I tt I U' Inspector: x ��� CONSTRUCTION <br />Facility Address: r01J $ <br />Well Address: Total Depth: <br />WP# n03'7j�j S Well#: >�w-b�3w-y Drilling Rig Type: <br />Soil Boring#: g"' Z/E�''S Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Drilling Company: Q�v►�w.c Qr„��;�..,, tcw— <br />Driller Onsite: 0 of � t�� �,, ,.� Screen Length From: To: <br />Consultant: ELM Filter Pack From: To: <br />Geologist: t✓La„✓l-- /'r l(J+ Bentonite From: To: <br />Grout From: To: <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 />611go] II&I <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total Depth: VI =F� <br />Depth to Water: <br />Grout Material: -+ N <br />Gallons of Grout Used lLow <br />❑Well Installation Edell Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout <br />MOver Drill <br />❑ Gravity &/remie ' ❑Other: <br />Water <br />gallons <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />b Bags <br />Thickest Thinnest <br />4 Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7,5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />'25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <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 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 />t <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 />