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SAN- OAQU I N <br />' —COUNTY— <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: MQ 101.E --Inspector: CONSTRUCTION <br />Facility Address: `'\" <br />Well Address: `C� P`�� \A N y01-3 Total Depth: <br />WP# �j \ 5 Well#: Drilling Rig Type: <br />Soil Boring#: Z 2. - 0 S Min 2" Annular EHD Seal Verified: <br />Drilling Company:y an W <br />❑ Yes ❑No <br />Screen Length From: To: <br />Driller Onsite: Filter Pack From: To: <br />Consultant: <br />Geologist: ��t,G..�.� , Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: P� Yes ❑ No' COMPLETION ❑ Stove Pipe ❑Christie Box <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 No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:�s (CLQ r <br />Depth to Water: <br />Grout Material: t'j 6— N c C. T 1 r. <br />Gallons of Grout Used: 6-> ( S'O' <br />❑Well Installation ❑Well Destruction <br />El Boring Installation /Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie ❑Other: <br />w�w11 <br />casing <br />Iff I <br />height <br />R- ff-- -w <br />ABOVE -GROUND CHAfSIY-BOX <br />compLETiON CdMPLETiON <br />Ground Sufacs ._. <br />VIAgrout <br />ft. <br />fi. <br />ft. <br />slatted :7 <br />ssc5on <br />Srn P -:k <br />ft. <br />MATERIALS/DEVELO PMENT <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 />f E <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 />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />#Bags <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 />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17,5 <br />7 <br />35 <br />70 <br />7 <br />20 <br />AO <br />40 <br />80 <br />B <br />w�w11 <br />casing <br />Iff I <br />height <br />R- ff-- -w <br />ABOVE -GROUND CHAfSIY-BOX <br />compLETiON CdMPLETiON <br />Ground Sufacs ._. <br />VIAgrout <br />ft. <br />fi. <br />ft. <br />slatted :7 <br />ssc5on <br />Srn P -:k <br />ft. <br />MATERIALS/DEVELO PMENT <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 />f E <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 />