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SAN 1UAQUIN <br />Environmental Health Department <br />couNTY <br />Greotne55 graves ;ere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Vzft inspector:. SIA-33yGKc <br />Facility Address: S3 S IS GV014-4— �( 4 -0 - <br />Well Address: <br />WP#.J?'¢ 1413TO Well#: <br />Soil Boring#: <br />Drilling Company: 0.S <br />Willoi- <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes []No <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 />If yes, material: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth:700 <br />Depth to Water: <br />Grout Material: P✓w �oMi {� <br />Gallons of Grout Used: <br />/ Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ;KTremie ❑Other: <br />CONSTRUCT ON <br />3v-/ <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: Z To: C7 <br />Grout From:, To: ,00- <br />COMPLETION ❑ Stove Pipe El Christie Box <br />fL <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/Cement Mix_ 3% Mix_ % Mix <br />Benioniie per 47 Ib 1.4'1 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 IF 209 464-0138 1 www.sicehd.com <br />Water <br />gallons ' <br />Cement <br />Bags <br />Water <br />alions <br />Cement 94lb <br />Bags <br />Thickest Thinnest <br />k Bags <br />Thickest Thinnest <br />x Bags <br />2.5 <br />5-- <br />— 1 — <br />—5 — <br />10 -- <br />—i - — <br />5 <br />10 1 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 1 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 1 <br />4 <br />20 1 <br />40 <br />4 <br />12.5 <br />25 1 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 1 <br />6 <br />30 1 <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 />CONSTRUCT ON <br />3v-/ <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: Z To: C7 <br />Grout From:, To: ,00- <br />COMPLETION ❑ Stove Pipe El Christie Box <br />fL <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/Cement Mix_ 3% Mix_ % Mix <br />Benioniie per 47 Ib 1.4'1 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 IF 209 464-0138 1 www.sicehd.com <br />