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Date: Inspector: Inspector: <br />140.1 <br />WP# CY) ti 6 I <br />Soil Boring#: <br />Drilling Company: @le° SX- • <br />Facility Ad ire <br />Well Address: <br />Driller Onsite: <br />Consultant: 1(4 42 itder . <br />Geologist: 5c,te • <br />Monitoring Well/Soil Boring Inspection Report <br />Air\a5;.. CONSTRUCTION <br />C*10 1566 \tQr Total Depth: <br />Well#: g 2, <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: D Yes LINo <br />To: <br />To: <br />To: <br />To: <br />From: <br />From: <br />From: <br />From: <br />casing <br />height <br />ABOVE-GROUND <br />COMPLETION CHFIISTY-BOX <br />COMPLETION <br />Ground Surlacs <br />grout <br />_ft <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows here <br />Environmental Health Department <br />Public Water System Onsite: D Yes IllNo <br />Domestic Well Onsite: El Yes ON° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: Yes LINo <br />SPOILS <br />Contamination Noted: E Yes DNo <br />If yes, spoils storage Location: <br />E Yes LINo <br />GROUTING or DESTRUCTION L41 .Depth: <br />Depth to Water: <br />Grout Material: \lain -WM <br />Gallons of Grout Used: / <br />El Well Installation El Well Destruction <br />DBoring Installation tgBoring Destruction <br />METHOD USED <br />DPressure Grout DOver Drill <br />LI Gravity IKIremie <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest #Bags <br />2.5 5 1 L.," 5 10 1 <br />5 10 2 L...- 10 20 2 <br />7.5 15 3 ,-- 15 30 3 <br />10 20 4 L.., 20 40 4 <br />12.5 25 5 i.,' 25 50 s <br />15 30 6 ../ 30 60 6 <br />17.5 35 7 ..-- 35 70 7 <br />20 40 . 8 Le,- _ 40 80 8 <br />COMPLETION El Stove Pipe El Christie Box <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 />Covered: <br />If yes, material: <br />()o‘c o r <br /> <br />tu%- -v 1.501v-Atit <br />1868 E. Hazelton Avenue I Stockton, California 95 <br />1 <br /> 05 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />10/16/2017