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SAN_:JOAQUIN Environmental Health Department <br />COUNTY <br />&eotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date:// 1( Inspector: S 3\"ek-( <br />Facility Address: VLO1 <br />Well Address: <br />WP# CXR y 202 Well#: <br />Soil Boring#: 1 3 <br />Drilling Company. /`1 i (� (�;✓�'� <br />Driller Onsite: <br />Consultant: i C�sM c —h <br />Geologist: <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 />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />CONSTRUCTION <br />Total Depth:_ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 6"t SO <br />Depth to Water: rJ -J-' <br />GroutMaterial: T e' -t Ce - n e -'t^ -c - <br />Gallons of Grout Used: - <br />❑Well Installation ❑Well Destruction <br />El Boring Installation KBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravityrem ie ❑Other: <br />Water <br />oallons <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />9 Bags <br />Thickest <br />5 <br />I Thinnest <br />10 <br />J Bags <br />1 <br />2.5 5 1 1 <br />5 10 1 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />9 <br />40 <br />80 <br />8 <br />it. <br />MATERIALS/DEVELOPM ENT <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 />Sentonite/Cement Mix 3% Mix_ 0% Mix <br />Bentonite per 47 Ib 1.41 2.4( <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />