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SKJOAQUIN Environmental Health Department <br />COUNTY— <br />�, <br />ticrFnPt' Greotness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />` <br />Cement 471b <br />Bas <br />Date: B (� Inspector: i <br />CONSTRUCTION <br />Thickest Thinnest <br />Facility Address: <br />Thickest Thinnest <br />4Bags <br />Well Address: <br />Total Depth: <br />5 10 <br />WP# 4 5 Well#: <br />Drilling Rig Type: <br />2 <br />Soil Boring#: ft FL 014 54i /� (�� <br />f331, "63 Min <br />7.5 15 <br />3 <br />2" Annular EHD <br />Seal Verified <br />Drilling Company:.C�rr�LL�vt <br />4 <br />20 40 <br />Driller Onsite: �o P c,(.ri�'> <br />Screen Length <br />From: <br />Consultant: <br />Filter Pack <br />From: <br />Glta u <br />Geologist: J <br />Bentonite <br />From: <br />17.5 3 <br />Grout <br />From: <br />Public Water System Onsite: ❑ Yes <br />❑Tlo COMPLETION <br />❑ Stove Pipe <br />Domestic Well Onsite: ❑ Yes ONo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />cpnll c <br />Contamination Noted: ❑ Yes GNo <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 30 , W,,Wt-tOj -t-OtWt"-tet <br />Depth to Water: M 0wL n• <br />Grout Material: 9� <br />Gallons of Grout Used: , T51:1 A MATERIALS/DEVELOPMENT <br />❑Well Installation ❑Well Destruction <br />El Boring Installation EXoring 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 />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />RBags <br />Thickest Thinnest <br />4Bags <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 1 25 <br />5 <br />25 50 <br />5 <br />151 Sq <br />6 <br />30 60 <br />6 <br />17.5 3 <br />7 <br />35 70 <br />7 <br />20 <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 2.821 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 />