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SAN JOAQUIN <br />COUNTY-- <br />Environmen Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: .5111" <br />Facility Address: '7.455-7 $ rr (>6.,..d..c. St- <br />Well Address: 7.413- çSA..." <br />WP # 00?gbel Well#: <br />Soil Boring#: GPI" la2 cti> A •-p—i <br />Drilling Company: CY\ftey) OTAAr,, <br />Driller Onsite: Tvry— <br />Consultant: 5res.As-,.....N <br />Geologist: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes 111No <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: Li Yes El No <br />Domestic Well Onsite: El Yes ONo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes ONo <br />SPOILS <br />Contamination Noted: El Yes 0 No <br />If yes, spoils storage Location: <br />Covered: D Yes II N o <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: i -t-gy <br />Grout Material: se,,c4-it <br />Gallons of Grout Used: <br />Well Installation DWell Destruction <br />Li Boring Installation Q13.ciring Destruction <br />METHOD USED <br />Pressure Grout 00ver Drill <br />111/6ravity 11"1--"re m ie DOther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cennent941b <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest #Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />COMPLETION 0 Stove Pipe 111 Ch rist e Box <br />casing <br />height <br />aiRisrticpox <br />comPLE-noN <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen 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 />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-3420 I F 209 464-0138 I www.sicehd.com