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SAN JUAQUIN <br />—COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: (7— 1'y -Z' Inspector: Al �+�t CONSTRUCTION <br />FacilityAddress:'I-MT 4 <br />Well Address: Total Depth: <br />WP# OO 1/3 5b Well#: Drilling Rig Type: <br />Soil Boring#: Al- -ed 86 <br />Drilling Company: Min 2" Annular EHD Seal Verified <br />Driller Onsite: Screen Length From: <br />Consultant: _a %e Filter Pack From: <br />Geologist: 'jE:hY Sm Y Bentonite From: <br />Grout From: <br />Public Water System Onsite <br />Domestic Well Onsite: <br />If yes, location and distance: <br />cnnnoi Mir_ <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />❑ Yes ❑No COMPLETION ❑ Stove Pipe <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOVE -GROUND CHRLST 43OX <br />COMPLETION COMPLETION <br />Ground Surlacs <br />grout <br />ft. <br />ft. <br />ft. <br />Contamination Noted: ❑ Yes ❑No /S/ <br />If yes, spoils storage Location: Z : �j slotted <br />sac�on <br />Covered: El Yes ❑ No l t L0 grswt Pads <br />If yes, material: <br />1 <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: ^-Ills ee_^e%,, <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />El Boring Installation Loring Destruction 'y tldll <br />METHOD USED f1'3 k' <br />'411 <br />❑Pressure Grout /ElOver Drill ee <br />[[�.�rL1dTre 1 ❑Other: <br />)& s4-10 <br />Water <br />gallons <br />Cement 471b <br />Bas <br />Water <br />eallIll ons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />4Bags <br />Thickest Thinnest <br />ttBags <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 />is <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />10 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />MATERIALS/DEVELOPM ENT <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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />