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SAN JOAQUIN <br />Environmental Health Department <br />—COUNTY— <br />, <br />Grevtness grcrls Isere. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 070ML,Inspector: 1 CONSTRUCTION <br />Facility A re -J I ` rA51. <br />Well Address: Total Depth: <br />WP# noq'55 Well#: Drilling Rig Type: <br />Soil Boring#: it Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Drilling Company: S lem, Snu <br />Driller Onsite: <br />men Ib <br />a s <br />Screen Length <br />From: <br />To: <br />Consultant: :jQ 1 0 AA <br />Filter Pack <br />From: <br />To: <br />Geologist: <br />Bentonite <br />From: <br />To: <br />2 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes ❑No <br />COMPLETION <br />❑ Stove Pipe <br />❑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 />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />❑ Yes ❑No <br />❑ Yes 11 No <br />❑ Yes ❑No <br />casing <br />� height: <br />ABOVE -GROUND c.HszTY-sox <br />COMPLEr10N COMPLETION <br />Ground Surtares .— <br />proLd <br />ft. <br />ft. _ <br />M <br />m' C <br />O <br />saaion 3 <br />Total Depth: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity PVrem�i� ❑Other: <br />X <br />JLl /� ATERIALS DEVELOPMENT <br />sing 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 />Water <br />allons <br />men Ib <br />a s <br />Water <br />allons <br />ment 94 lb <br />Bags <br />Thi b_st Thinnest <br />s <br />Thickest Thinnest <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 />35 707 <br />20 40 <br />8 <br />40 80 <br />8 <br />Screen Feet <br />Bentonite/Cement Mix <br />3% Mix 5% Mix <br />Bentonite per 47 Ib <br />1.41 2.47 <br />Bentonite per 94 Ib <br />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 />