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. Q° c°`:SKJOAQUIN <br />Environmental Health Department <br />—C <br />Cement 941b <br />Bags <br />Greatness grows here. <br />k Bags <br />Monitoring Well/Soil Boring Inspection Report <br />I <br />Date: 4;(21 kL Inspector: (Oa7n`R k4',7 <br />CONSTRUCTION <br />Facility Address: &1D !j (jq <br />5 10 <br />Well Address: <br />Total Depth: <br />WP# Cb ` -13,39, fjLI3,3b' Well#. <br />-)rilling Rig Type: <br />Soil Boring#: V, I <br />� Min 2" Annular EHD Seal Verified: El Yes ❑No <br />Drilling Company: ��/�tY/�� <br />Driller Onsite:r� eScreen <br />Length From: To: <br />Consultant: r466 �r"f"Z • <br />Filter Pack From: To: <br />Geologist: 7�urte,`s� � <br />Bentonite From: To: <br />12.5 25 <br />Grout From: To: <br />Public Water System Onsite <br />Domestic Well Onsite <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 El No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes El No <br />❑ Yes El No <br />❑Christie Box <br />If yes, material: <br />GROUTING or DESTRUCTION Total e De th- oiix 5. <br />Depth: � SGS X t <br />Depth to Water: 7 3- r n' <br />Grout Material: MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />RIGravity F!�Tremie ❑Other: <br />t1., Gaies <br />Water <br />gall s <br />Cement Ib <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />k Bags <br />Thickest Thinnest <br /># 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 50 <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 />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 />i <br />l �-O �a I 3U buss <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 <br />10/16/2017 <br />F 209 464-0138 1 www.sicehd.com <br />