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SAN)JOAQUIN <br />N Environmental Health Department <br />COUNTY <br />Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 12c22 Inspector: r+�� <br />Facility Address: <br />Well Address: 2-101Pc.� <br />WP#yp wti �'4.L Well#: <br />Soil Boring#: pL1, .D`i, lbs,DL ��d, Iq <br />Drilling Company: L„ �'k <br />Driller Onsite: <br />Consultant: \'O"k14cC��ty <br />Geologist: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />M.,.I.,■E.rN <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />From: <br />Filter Pack <br />From: <br />Bentonite <br />From: <br />Grout <br />From: <br />❑ Yes El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />0-4 <br />GROUTING or DESTRUCTION Total Depth: I - 3oa <br />Depth to Water: kw <br />Grout Material: tioLA (f.1L A-4' <br />Gallons of Grout Used: <br />❑Well Installation []Well Destruction <br />❑Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />P Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />eallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />tlBags <br />Thickest Thinnest <br />Jt Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 so <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />ft. <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 />ft. <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 />`L\Q 4�4'15 J(b )Dot55 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />