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SANJ0AQUIN <br />—COUNTY— <br />Greatness grows here, <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Repor- <br />Date:�������J1' Inspector: CONSTRUCTION <br />Facility Address: <br />Well Address: Total Depth: <br />WP# v11,V —We ll#: Drilling Rig Type: <br />Soil Boring#: <br />Company:'h Min 2" Annular EHD Seal Verified: <br />Drilling <br />Driller Onsite: Screen Length From: <br />Consultant: (���+JSrOti� a``�t Filter Pack From: <br />Geologist: <br />Bentonite From: <br />M-��,Ch�. Grout From: <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />cAnAPI Inlr <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 E] No <br />❑ Yes El No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:�`O <br />Depth to Water: <br />Grout Material: 1� p <br />Gallons of Grout Used: .�^n S <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation)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 />Rall ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />n <br />14> <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 />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 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 1 Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />