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SANo7J0AQUIN <br />Environmental Health Department <br />COUNTY— <br />Greatness <br />OUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 1Z/iOrZf Inspector: <br />Facility Address: 7775S!t, uaan nS� <br />Well Address: <br />WP# C -7-7-7 U Well#: <br />Soil Boring#: VA V/ OZ C) <br />Drilling Company: <br />Driller Onsite: <br />Consultant:�D ✓XGo <br />Geologist: "'JASC"7 ore— <br />Public Water System Onsite: ❑ Yes r/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 />❑ Yes []No <br />❑ Yes 11 No <br />Covered: ❑ Yes ❑ No <br />CONSTRUCTION <br />Total Depth: — <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />COMPLETION ❑ Stove Pipe <br />If yes, material: Z 3 <br />.J <br />GROUTING or DESTRUCTION Total Depth`, 25� I t5 <br />Depth to Water: <br />Grout Material ��� <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />- �--zTr^- casing <br />height <br />ABOVE -GROUND CHA1S'IY 80X <br />cor�sPi>` r�ort GC4AF tEnON <br />t3rotind 5ucfxs <br />grout <br />fi. <br />fi. <br />ft. <br />0 <br />- o <br />started � = � <br />stc5on <br />4 <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation [Poring Destruction <br />METHOD USED <br />❑Pressure Grout Dover Drill <br />Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />2.j 7 <br />5 18 <br /># Bags <br />2 <br />Thickest Thinnest <br />L I] <br />10 20 <br /># Bags <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 1 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 130 <br />6 <br />30 <br />60 <br />6 <br />17.5 1 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <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 />lBentoniteXement Mix 3%, Mix 5% Mix <br />13eiltUnliE p�� =1 Ib I A-1 2.41 <br />Bentonite per 94 Ib 2.82 4.7 <br />r <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />