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SAW JOAQUm Environmental Health Department <br />COUNTY <br />G-eatrress g -ows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: /4'/Z j Inspector: <br />Facility Address: �7; ctv-c <br />Well Addres�: <br />WP# i .1� Well#: M1,1f <br />Soil Boring#: <br />Drilling Company: " � ! � <br />Driller Onsite: <br />Consultant: <br />Geologist: 4g;��\/ CA AA <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 />epnll C <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: gt <br />❑ Yes UNo <br />❑ Yes ❑No <br />❑Yes ❑ No <br />❑ Yes ❑No <br />GROUTING DESTRUCTION �'otal Depth: `?b <br />Depth to Wat <br />Grout Material: /JQ r <br />Gallons of Grout Used: <br />❑Well Installationxs*� <br />W ell Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />Li Pressure Grout ,Aver Drill <br />❑ Gravity T <br />remie ❑Other: <br />Water Cement 471b Water Cement 941b <br />all <br />ons <br />Bas <br />5% Mix' <br />allons <br />Ba s <br />Thickest <br />Thinnest <br />tlBags <br />4.7 <br />Thickest <br />Thinnest <br />ttBags <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 />slottad <br />20 <br />40 <br />4 <br />1245 <br />25 <br />5 <br />25 <br />50 <br />5 <br />is <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />4 <br />VVEOGROUND <br />CHMM4 <br />:. <br />.. -grout <br />tt. <br />me <br />3% Mix <br />5% Mix' <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />_ <br />2.82 <br />4.7 <br />slottad <br />sat on <br />s3. <br />— <br />— <br />. 0:0 <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/Gement 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 I Stockton, California 95205 I T 209 468-3420 � F 209 464-0138 I www.sicehd.com <br />