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!7uPG SAN JOAQUIN <br />< ,; Environmental Health Department <br />--COUNTY— <br />`•.•arKOR - Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Z 16.7•if Inspector: 'I ifs CONSTRUCTION <br />Facility Address:.2 4 0 Rc Heorq hue. <br />Well Address: Total Depth: _ <br />W# w p u n %LkImCb Well#: Drilling Rig Type: <br />Soil Boring#: )51 Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Drilling Company: VL 0luy\ <br />Screen Length From: To: <br />Driller Onsite: <br />Consultant: L Filter Pack From: To. <br />Geologist: Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑Yes F-1 Ki <br />Domestic Well Onsite: ❑Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: WL' <br />Grout Material: eA G <br />Gallons of Grout Used: SP> 6111 . <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation B•Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity Lt <br />-Tremie ❑Other: <br />COMPLETION <br />❑ Stove Pipe ❑Christie Box <br />i <br />:. <br />..CHRISTYACOMPLETICN <br />`u <br />L <br />n. <br />Cement 471b <br />Bas <br />5% Mix <br />Water <br />gallons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />uBags <br />4.7 <br />Thickest <br />Thinnest <br />kBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />slottaf <br />20 <br />= <br />4 <br />s"acdon <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />ATERIALS/DEVELOPMENT <br />Water <br />allons <br />Cement 471b <br />Bas <br />5% Mix <br />Water <br />gallons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />uBags <br />4.7 <br />Thickest <br />Thinnest <br />kBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />M <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 />tt. <br />Screen Feet <br />Bentonite/Cement Mix <br />3% Mix <br />5% Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1068 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />