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- SANiJOAQUIN <br />Environmental Health Department <br />—COUNTY— <br />=`;'' Greatness grows there, <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: CONSTRUCTION <br />Facility Address: \'\ b \�J ��s•5 9�� <br />Well Address: a 4 Total Depth: <br />WP# �v\x'j Well#: P Drilling Rig Type: <br />Soil Boring# r •,<,- -`1 . VI . 13"A \1-,\� „ <br />ALO Min 2 Annular EHD Seal Verified: ❑Yes ❑No <br />Drilling Company: <br />Driller Onsite: Screen Length From: To: <br />CoQ_ <br />L5<� N Yi Filter Pack From: To: <br />Consultant: <br />Geologist: Bentonite From: To: <br />Public Water System Onsite: ❑ Yes VNo <br />Domestic Well Onsite: V1 Yes ❑No <br />If yes, location and distance: Ic <br />CANAPI IN(, <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted <br />❑ Yes ❑No <br />❑ Yes /No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes �No <br />If yes, material: <br />i <br />GROUTING or DESTRUCTION Total Depth: l.�D <br />Depth to Water: <br />Grout Material: �1 <�, pt�< , k <br />Gallons of Grout Used: q� ora <br />[]Well Installation ❑Well Destruction <br />El Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity C�Tremie ❑Other: <br />Water <br />Cement 471b <br />Bas <br />Water <br />i2aill ons <br />Cement 941b <br />Bags <br />—gallons <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 ly <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height , <br />ABOVE -GROUND c4-991s7Y aox <br />COMPLETION COMPLETION <br />Ground 3taixcs <br />proof <br />ft. <br />f2. _ <br />m <br />0 <br />ts=on — <br />_ 9-3+ Pack <br />#i.I F= fi. <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 5% Mix <br />Bentonite per 47 Ib 1 1.411 2.47 <br />Bentonite per 94 Ib 1 2.821 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 />