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SAN`°JOAQUIN Environmental Health Department <br />COUNTY <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: -. Inspector: (T iY'r�t CONSTRUCTION <br />FacilityddA ress: <br />Well Address: - �r Total Depth: <br />WP# 41 33, Well#: Drilling Rig Type: <br />Soil Boring#: �TCZ Min 2" Annular EHD Seal Verified <br />Drilling Company: l rLe(^ Screen Length From: <br />Driller Onsite: (( I'.rr,� ,[ 5vb k l�erw`r*✓vbt7 <br />Consultant: <br />Filter Pack From: <br />Geologist: 45,C rav a.tiBentonite From: <br />Grout From: <br />Public Water System Onsite: ❑ Yes [No COMPLETION ❑ Stove Pipe <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />EW6 <br />SAMPLING <br />Cement 94 lb <br />Bags <br />Holding Temperature: <br />4Bags <br />Thickest Thinnest <br />Method: <br />2.5 <br />5 <br />Screening Method: <br />5 <br />10 <br />Verified Chain of Custody: <br />❑ Yes <br />❑No <br />SPOILS <br />10 <br />20 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />15 <br />30 <br />Covered: <br />❑ Yes <br />❑No <br />If yes, material: <br />20 <br />40 <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CNqtSTr-aox <br />COM?LE ION COMPLETION <br />Ground Satan <br />grout <br />n. <br />n. <br />0 <br />_ o <br />stomd <br />s*ctcn <br />prawt pack <br />GROUTING or DESTRUCTION Total Depth: '712 77 L7 <br />Depth to Water: �Pv J- Rid )-V n. <br />n. <br />Grout Material: 0 4-A <br />MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: <br />C T <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation El Boring 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 />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />9Bags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <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 />asing ype. <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 1.41 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 www.sicehd.com <br />