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SAN JOA UIN <br />E Q Environmental Health Department <br />COUNTY- <br />�c <br />\C'IQFD11;. Greatness grows {fere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: )41010 Inspector: Ct�a` Ir1 G 5 <br />Facility Address:gz�t (k6 _ML U\Y SAy%c <br />Well Address: <br />WP# W SUV <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />�- CAZCIh <br />Consultant: I�YU.ZGV►'� <br />Geologist: <br />Public Water System Onsite: ❑ Yes ❑No <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: ❑ Yes 11 No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑ No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 46U i ` <br />Depth to Water: ()b <br />Grout Material: r\ezut C'eweet <br />Gallons of Grout Used: � 2 <br />❑Well Installation ❑Well Destruction <br />El Boring Installation [q -Boring <br />Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />D Gravity p <br />Tremie ❑Other: <br />Water Cement 471b Water Cement 941b <br />alIII ons Bags gallons <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />Z IMF <br />i <br />K <br />V/ <br />VEoGROUND <br />:. <br />.OIVIPILETION <br />ft. <br />3% Mix <br />5% Mix <br />Ba s <br />Thickest <br />Thinnest <br />q Bags <br />4.7 <br />Thickest <br />Thinnest <br />Bags <br />2.5 <br />5 <br />1 sr <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 f/ <br />10 <br />20 <br />2 <br />75 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />1245 <br />25 <br />5 <br />25 <br />50 <br />5 <br />30 <br />60 <br />6 <br />15 <br />30 <br />6 <br />sacdon <br />70 <br />7 <br />17.5 <br />35 <br />735 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />Z IMF <br />i <br />K <br />V/ <br />VEoGROUND <br />:. <br />.OIVIPILETION <br />ft. <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 />•tottad <br />sacdon <br />Igr <br />tt. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen <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 />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 />1868 E. Hazelton Avenue � Stockton, California 95205 I T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />