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j; SAKJOAQUIN <br />-. Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date:Inspector: CONSTRUCTION <br />Facility Address: 6Ov. <br />Well Address: N Total Depth: <br />WP# \-\�'„\o�A Well#: Drilling Rig Type: <br />Soil Boring#: -1 , S3 s <br />Drilling Company: Com an 5�, Min 2„ Annular EHD Seal Verified: El Yes El No <br />Driller Onsite: \-,-, N � Screen Length From: To: <br />Consultant: L f;R VJ Fc73.fl RSs_F�. Filter Pack From: To: <br />Geologist: p� (L-��'� Bentonite From: To: <br />g �' Grout From: To: <br />Public Water System Onsite: ❑ Yes �No <br />Domestic Well Onsite: ❑ Yes �No <br />If yes, location and distance: 1 <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Cement 471b <br />Bas <br />Verified Chain of Custody: <br />❑ Yes ❑No <br />SPOILS <br />Thickest Thinnest <br />Contamination Noted: <br />❑ Yes �No <br />If yes, spoils storage Location: <br />2.5 s <br />Covered: <br />❑ Yes /No <br />If yes, material: <br />1 <br />GROUTING or DESTRUCTION Total Depth: vb <br />Depth to Water: C) k <br />Grout Material: <br />Gallons of Grout Used: foo c�A <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation/Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity 4Tremie []Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#t a s <br />Thickest Thinnest <br />##Bags <br />2.5 s <br />1 <br />5 <br />10 <br />1 <br />5 <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 <br />7 <br />20 1 40 <br />8 <br />40 <br />80 <br />8 <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND cmMW-Box <br />COWLErlON COMPLETION <br />Groun l surface <br />grout <br />ft. <br />tt. <br />ft. <br />0 <br />— o <br />slotted <br />sec5on — <br />yttvet pack <br />MATER IALS/DEVE LO PM ENT <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 />