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SAN:10A0UIN <br />--COUNTY— <br />Greotness grows here <br />Environmental Health Department <br />Monitoring ell/Soil Boring Inspection Repor <br />Date: N5%r-,'�,`L-LQILFnspector: CONSTRUCTION <br />Facility Address:Q <br />Well Address: N �c3\ Total Depth: <br />WP# h2,(c � 1A Well#: Drilling Rig Type: <br />Soil Boring#: <br />Min 2" Annular EHD Seal Verified: <br />Drilling Company: <br />Driller Onsite: v` 1,4 V_. Screen Length From: <br />Consultant: `��vJ���-� �,,. ���� Filter Pack From: <br />Geologist: Bentonite From: <br />Grout From: <br />Public Water System Onsite: ❑ Yes j No <br />Domestic Well Onsite: ❑ Yes JN 0 <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 />Covered: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />If yes, material: `� <br />GROUTING or DESTRUCTION Total Depth: jq <br />Depth to Water: ' <br />Grout Material: <br />Gallons of Grout Used: S� <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation C 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 />gall ons <br />Cement 94 lb <br />Baes <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />#Bags <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 />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 />25 <br />50 <br />5 <br />15 <br />0 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />COMPLETION ❑ Stove Pipe <br />❑ Yes El No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />n <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 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 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />