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SAN 1QAQUIN <br />—COUNTY— <br />Greatness grows he,c. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: CONSTRUCTION <br />Facility A dress: nps�'S 4lZ`CN C l�o�►-�� l� <br />Well Address: Total Depth: <br />WP# bna0'i b'] Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: ti -yf' �� Q ��� tk\ S/aN Min 2" Annular EHD Seal Verified: <br />�\� "'� 'u4 .��L.oN <br />❑ Yes ❑No <br />Driller Onsite: Nb S �- o,"C' <br />Screen Length <br />From: <br />To: <br />Consultant: <br />Filter Pack <br />From: <br />To: <br />Geologist: 'Tck, <br />Bentonite <br />From: <br />To: <br />\C") <br />Grout <br />From: <br />To: <br />Public Water System Onsite: E] Yes INo <br />COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite: ❑ Yes 6No <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 />❑ Yes ❑No <br />❑ Yes ❑No <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTI N Total Depth:_��\�� <br />Depth to Water: N JA <br />Grout Material: �1 V C < N\&►t <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation gBoring Destruction <br />METHOD USED <br />❑Pressure Grout Dover Drill <br />❑ Gravity Vremie ❑Other: <br />Water <br />ilons <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Bags <br />Thickest Thinnest <br /># Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <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 />is 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 />8 <br />1 40 <br />80 <br />8 <br />casing <br />+� height <br />ABOVE -GROUND GFiRSSTY-30X <br />COWFL.ETION COMPLETION <br />t3rouna seta" + --... <br />grout <br />ft. <br />tt. <br />ft. <br />j,< w <br />K C <br />O <br />siottsd S _ 'Z <br />sacJon <br />E — Grswt pack <br />JL <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/Gement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />r i <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 />