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SAN�IOUN <br />Environmental Health Department <br />— <br />{• COUNTY— <br />,`qcP / Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: f 1''� Inspector: of �L <br />Facility Address: i"'VoJ �y C low rt. tri <br />Well Address: <br />WP# w J.) Ckt-A' Well#: 7 _ <br />Soil Boring#: ) l -1 P 3 1 t0 <br />Drilling Company: <br />Driller Onsite: FW <br />Consultant: Jn) t ILL. _ ; JL <br />Geologist: aLy <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 />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: tS-3� <br />Depth to Water: 12V <br />Grout Material: p).t LLV.A k <br />Gallons of Grout Used: D <br />❑Well Installation ❑Well Destruction <br />El Boring Installation 4oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />KGravity VTremie ❑Other: _ <br />❑ Yes []No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND C iRZ_rY-BOX <br />COMPLETION COMPLETION <br />Ground Suriacs <br />grout <br />tt. _ <br />=v = <br />_ o <br />slotted = B <br />soon <br />_ = craw+ pack <br />ft. I F� tt. <br />t� MATERIALS/DEVELOPMENT <br />D `p_ t�6sing Type: <br />t3lank 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 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />Water <br />allons <br />Cement 47 lb <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thic <br />st Thinnest <br />ttBags <br />Thickest Thinnest <br />NBags <br />1.5 <br />5 <br />1 <br />5 10 <br />1 <br />10 <br />10 20 <br />2 <br />7.5 <br />15 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />20 <br />40 <br />8 <br />40 80 <br />8 <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />