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SANsJOAQUIN <br />—COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Repor <br />Date: Zl Inspector: CONSTRUCTION <br />Facility Address: \�nla,EYC> !�. C r jt k L. -yC C2, 00Q <br />Well Address: 5 (F!!,� N %b V J�_ Total Depth: _ <br />WP#_ \­�'L\'1 U Well#: Drilling Rig Type: <br />Soil Boring#: - l—, Min 2" Annular EHD Seal Verified: <br />Drilling Company: Qn s Screen Length From: <br />Driller Onsite: Lz_g::-C� <br />Consultant: Filter Pack From: <br />Geologist: Bentonite From: <br />Grout From: <br />Public Water System Onsite: Yes ❑No <br />Domestic Well Onsite: ❑ Yes jL1No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes �No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes UNCI <br />If yes, material: <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />GROUTING or DESTRUCTION Total Depth: <br />-Z� <br />Depth to Water: \ <br />K- n' <br />Grout Material: Q sw_�R <br />Cement 941b <br />Bags <br />Gallons of Grout Used: �� a d, c MATERIALS/DEVELOPMENT <br />#Bags <br />Casing Type: <br />❑Well Installation ❑Well Destruction <br />Blank Feet Screen Feet <br />5 <br />iz <br />Slot Size: <br />El Boring Installation Boring Destruction <br />Bags Cement: <br />METHOD USED <br />Bags Sand/Gravel: <br />10 <br />Type/Brand of Bentonite: <br />❑Pressure Grout ❑Over Drill <br />Filter Pack Type/Size: <br />�Gravity ❑Tremie ❑Other: <br />Type of Method: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <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 />20 <br />40 <br />4 <br />12,5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />3 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />