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SANJOAQUIN <br />• �'r�aj. `j -COUNTY— <br />'= err <br />• 94�ivo�c Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2 -/ ZZ Inspector: StJJ�(ki CONSTRUCTION <br />Facility Address: (1J Z 16, ltif ) Q-, 3 t-DcKta •ti, <br />Well Address: Total Depth: <br />WP# v Well#: Drilling Rig Type: <br />Soil Boring#: F ' Z -0 3 Z <br />Drilling Company: e Min 2" Annular EHD Seal Verified: <br />��Y <br />❑ Yes []No <br />Driller Onsite: Screen Length From: To: <br />Consultant:, Filter Pack From: To: <br />Geologist: _� Vj jC6kBentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <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: ❑ 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: S <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: --Yo �u(/ 0 <br />❑Well Installation ❑Well Destruction <br />❑Boring InstallationINAoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity Tremie ❑Other: <br />�L <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 <br />Oenloriiie per 47 Ib <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />izallons <br />2.82 <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />2.5 5 <br />#Bags <br />1 <br />Thickest Thinnest <br />#Bags <br />5 <br />10 <br />— <br />2 <br />10 <br />20 <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 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />�L <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 <br />Oenloriiie per 47 Ib <br />3% Mix <br />- i 4 I <br />5% Mix <br />- 2.4,` <br />Bentonite per 94 Ib <br />2.82 <br />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 />