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•I '� m SANA0AUI Environmental Health Department <br />COUNTYGreatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 115 i o Inspector: <br />Facility Add ess: 11101 &(q-ed-t R.pt <br />Well Address: <br />WP#_ IVP ()�) ;? 00 Cl Well#: <br />Soil Boring#: <br />Drilling Company: V W <br />Driller Onsite: AnCi2 <br />Consultant: �•��i�1elCl e Y <br />Geologist: tYV6 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes TtNo COMPLETION ❑ Stove Pipe []Christie Box <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes <br />�01\lo <br />SAMPLING <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Holding Temperature: <br />Thickest Thinnest <br />#Bags <br />Method: <br />1 <br />5 <br />Screening Method: <br />1 <br />5 10 <br />Verified Chain of Custody: <br />❑ Yes <br />❑No <br />SPOILS <br />7.5 15 <br />3 <br />Contamination Noted: <br />❑ Yes <br />❑No <br />If yes, spoils storage Location: <br />4 <br />20 <br />Covered: <br />❑ Yes <br />❑No <br />If yes, material: <br />I <br />GROUTING or DESTRUCTION Total Depth: _ Vi <br />U 13 { t <br />Depth to Water: !C� u /1 <br />Grout Material• �[✓�l�Ct?h1C10 <br />casing <br />height <br />T <br />.s.8o�—E-3aDur7iT c+RtsT _aox <br />Gdh�LET)oN GotAFLETJON <br />G.�;na suixs <br />Dr1ovt <br />ft. <br />-- o <br />sion2d r. _ <br />soon <br />tks <br />ttI F= tt. <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />❑Well Installation E Well Destruction <br />[]Boring Installation tBoring Destruction <br />METHOD USED <br />OPressure Grout ❑Over Drill <br />❑ Gravity %Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />Rall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />6'Bags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 1 35 <br />7 <br />35 <br />70 I <br />7 <br />20 1 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 />eentonitelCeMont Mix 3% tulix 5% Mix <br />Bentonite per 47 Ib 1 1.41 2.47 <br />Bentonite per 94 lb 1 2.821 4.7 <br />10/16/201.7 <br />1888 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 X164-0138 1 www.sicehd.com <br />