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Environ men SAN:JOAQUIN <br />COUNTY <br />Greatness grows here. <br />- Health Department <br />CI Gravity Egli<mie <br />Feet Feet Screen <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: Iry C <br />Facility Address: 7...A.5-7 CI <br />Well Address: 1,..04.0 5 1.;" I <br />WP# 00 3? VI Well#: <br />Soil Boring#: &el c-{ <br />Drilling Company: evn, <br />Driller Onsite: r <br />Consultant: <br />Geologist: <br />Public Water System Onsite: CI Yes ON° <br />Domestic Well Onsite: LI Yes ON° <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: LIlYes LINo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: tAk <br />Depth to Water: <br />Grout Material: 1\-e...k. <br />Gallons of Grout Used: <br />ElWeIl Installation OWelr"Destruction <br />CI Boring Installation Poring Destruction <br />METHOD USED <br />OPressure Grout 1110ver Drill <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <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 G 30 GO 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: CI Yes DINo <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION CI Stove Pipe DIChristie Box <br />casing <br />height <br />To: <br />To: <br />To: <br />To: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank <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 T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />El Yes ElNo <br />Yes D No