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SAN.AAQUIN <br />Environmental Health Department <br />COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: \-V..30-\ Inspector:%iktik‘i CONSTRUCTION Q./vas <br />WO' Facility Address: \\\Sc.1, c:\°\ i ct.t%•-•-t--,t__Ab.‘,)-3 Dervjirik,- <br />Well Address: 1,..c.‘,Q-• \k\t...". CV\ Total Depth: <br />WP# ,--\\\t\\ Well#: ---- Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: CI Yes El NI o <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />Soil Boring#: N__ <br />Drilling Company: cInge ,-3\j\k)-e\j\flitewir. <br />Driller Onsite: <br />Consultant: Nk....\iCtic.).) CrCe—x—s)v.S__ — <br />Geologist: Q\SCX)k.--A.-- <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />Public Water System Onsite: Yes No <br />Domestic Well Onsite: <br /> <br />0 Yes ONo <br />If yes, location and distance: <br />SAMPLING \3 <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes 0No <br />SPOILS <br />Contamination Noted: 0 Yes ElNo <br />If yes, spoils storage Location: <br />Covered: 111 Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: (0) <br />Depth to Water: <br />Grout Material: N <br />Gallons of Grout Used: <br />OWell Installation El Well Destruction <br />0Boring Installation Boring Destruction <br />METHOD USED <br />CI Pressure Grout 00ver Drill <br />CI Gravity 4Trernie 00ther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest 8 Bags Thickest Thinnest #Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 3 15 30 3 <br />10 1/ <br />c---45,. <br />Sc5 <br />20 40 4 <br />12.5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 e <br />COMPLETION El Stove Pipe <br /> LI Christie Box <br />casing <br />height <br /> <br />C8.RISTY-p0X <br />COMPLETION <br />ft <br />ft <br />_ft <br />slettad <br />socton <br />ft. <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 />ft. <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