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SAN'�JOAQUIN <br />Environmental Health Department <br />—COUNTY— <br />_ Greatness grows here. <br />Public Water System Onsite: <br />Monitoring Well/Soil Boring Inspection Report <br />Domestic Well Onsite: <br />❑ Yes /No <br />If yes, location and distance: <br />Date: ��VVZlnspector. <br />//�� <br />CONSTRUCTION <br />Faci1 Address: <br />3 t-� <br />Method: <br />Well Address: <br />Screening Method: <br />Total Depth: <br />WP# V <br />Well#: <br />Drilling Rig Type: <br />Soil Boring#: �L �40Lc, , DLP <br />Min 2" Annular EHD Seal Verified: El Yes []No <br />Drilling Company: <br />�o�ss 5 C.,c�jr�ZT qn <br />2 <br />sl e: <br />A�Z OLS G�AQ- !rA G, <br />Screen Length From: To: <br />Consultant:tip <br />f=N(A 1"L(r <br />Filter Pack From: To: <br />Geologist: 14_� <br />L.f_ - <br />Bentonite From: To: <br />20 <br />40 <br />Grout From: To: <br />Public Water System Onsite: <br />Yes ❑No <br />Domestic Well Onsite: <br />❑ Yes /No <br />If yes, location and distance: <br />SAMPLING <br />#Bags <br />Holding Temperature: <br />#Bags <br />Method: <br />5 <br />Screening Method: <br />5 <br />Verified Chain of Custody: <br />❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes /No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes /No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 5 �, <br />Depth to Water: � r <br />Grout Material: N <br />Gallons of Grout Used: Gd <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation 013oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity oTremie ❑Other: <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <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 />50 <br />5 <br />15 <br />3 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />B <br />COMPLETION ❑ Stove Pipe ❑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 S% 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 />