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f2 : SANJOAQUIN <br />Environmental Health Department <br />" Le i'—COUNTY— <br />, <br />e` Gi ss grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2 �Inyect r: CONSTRUCTION <br />dd <br />Facility Aress: 1 <br />Well Address: Total Depth: <br />WP# o0q5U1 Well#: Drilling Rig Type: <br />Soil Boring#:Min 2" Annular EHD Seal Verified: <br />Drilling Company: <br />Driller Onsite: _�_jn1� Or <br />Screen Length From: <br />Consultant: f tk( (Wirt . Filter Pack From: <br />Geologist: d61J ig oifi'1�4 Bentonite From: <br />Grout From: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />❑ Yes 11 No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total pDepth: 01. <br />Depth to Water: i 6- <br />Grout Material: 2 (',►rl <br />Gallons of Grout Used: /-l. <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation RLBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity JSTremie ❑Other: <br />Water <br />allons <br />Cerr*nt 471b <br />Bas <br />Water <br />allons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />gs <br />Thickest Thinnest <br />b Bags <br />2.5L <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 />20 <br />4 <br />20 <br />40 <br />4 <br />5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />L20 <br />30 <br />6 <br />30 <br />60 <br />6 <br />5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />1 <br />40 <br />8 <br />40 <br />80 <br />B <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑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 />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 />10/16/2017 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />