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SAN =,JOAQUIN <br />—COUNTY— <br />Greatness groins here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �� 1j� 1�� Inspector: <br />Facility Address: , M5 <br />Well Address: <br />WP# M u4 titr'i Well#: <br />Soil Boring#: <br />Drilling Company:.,\ iy <br />Driller Onsite: ?Q�ak S�.V�NS <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes ❑No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />CONSTRUCTION `off " - <br />�P��.�i <br />Total Depth: <br />Drilling Rig Type: <br />��jQ�l�rNAnnular EHD Seal Verified: ❑ Yes El No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: �To: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />t <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />[--]Well Installation ❑Well Destruction <br />El Boring Installation1*oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity *Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eall ons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />ttBags <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 />s0 <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 />8 <br />40 <br />80 <br />8 <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />tt. <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 />La <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 3% 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 wvvw.sicehd.com <br />