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SAN 10AQUIN <br />—COUNTY— <br />_ Greatness graivs here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: �'l Nu-L1��t pector: ��"� CONSTRUCTION <br />Facility Address: <br />Well Address: Total Depth: <br />WP# q '�, 5 1 Well#: N Drilling Rig Type: <br />Soil Boring#: . 4 — (o �, 32. Min 2" Annular EHD Seal Verified: <br />Drilling Company: lD- P <br />❑ Yes ❑ No <br />Driller Onsite: D' Z�° Screen Length From: To: <br />�1•� [�F� <br />Consultant: �_ fie, Filter Pack From: To: <br />Geologist: jV� !� T Bentonite From: To: <br />(� • --Grout From: To: <br />Public Water System Onsite: ❑ Yes 0 N COMPLETION ❑ Stove Pipe []Christie Box <br />Domestic Well Onsite: ❑ Yes ❑No <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 />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />r ' 5'U <br />GROUTING or DESTRUCTION Total Defp3p"2' <br />pth: � <br />Depth to Water: A <br />2.0 <br />Grout Material: <br />Gallons of Grout Used: \ Z-"o� c► <br />[]Well Installation❑ ell Destruction <br />❑Boring Installation Boring Destruction <br />m!hier.1&11Ny1k1 <br />❑Pressure Grout ❑Over Drill <br />YGravity ❑Tremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />allons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />Jt Bags <br />2.5 5 <br />1 <br />5 <br />10 <br />1 <br />5 10 <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 <br />5 <br />25 <br />50 <br />5 <br />15 0 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />35 <br />70 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />1 2.(j'--- <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 3% 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 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />