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SAN JOAQUIN <br />fh,r `i COUNTY <br />gLiFoa�'� ' / Greatness grows here, <br />Date: goof <br />Facility Address: <br />Well Address: 'V <br />W P#Li <br />Soil Boring#: <br />Drilling Comr <br />Driller Onsite: <br />Consultant <br />Geologist: <br />Environmenwi Health Department <br />Monitoring Well/Soil Boring inspection Report <br />i Inspector: I CONSTRUCTION <br />B o a RSI 6m <br />Total Depth: <br />Well#: Drilling Rig Type: <br />Public Water System Onsite: <br />Domestic Well Onsite: <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 />❑Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />Covered: ❑Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: So �ie <br />Depth to Water: <br />Grout Material: V& . : <br />Gallons of Grout Used: ^(o DO qo-Iior4S <br />J <br />'Well Installation ❑Well Destruction <br />/❑ Boring Installation ❑ Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity <br />�fremie <br />❑Other: <br />Water Cemen 471b Water Cement <br />allons <br />0 6 <br />1, is <br />Bags <br />% N1ix <br />allons <br />Ba s <br />Thickest <br />Thinnest <br />Bags <br />4.7 <br />Thickest <br />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 />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 />f <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From:14 N S <br />Filter Pack From: 'I1 s To: <br />Bentonite From: SD To: <br />Grout From 1 I <br />COMPLETION ❑Stove Pipe <br />c 80 — 6 31 ' r 2.2.S'1 <br />ly.2Sr'D <br />5(Yes ❑Nc <br />To: l b 325'—yoS`sso; <br />]Christie Box <br />To: <br />itsea <br />Zsf sbttad :;: <br />Q S aattion a _ <br />Ova <br />S aM -�— <br />n- <br />5 > <br />�s <br />wee <br />pack <br />3 <br />Z' <br />.S <br />I <br />MATERIALS/DEVELOPMENT <br />Casing Type: �. S f 5 L� go C <br />Blank Feet5Zp. 4 Screen �� Feet To <br />Slot Size: D. b9zo <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: 3 SoL✓t <br />Type of Method: <br />BentonitefOement Nlix <br />3°I° It+fix <br />% N1ix <br />Bentonite per 4l Ib <br />1.41 <br />Bentonite per 94 Ib <br />2082 <br />4.7 <br />1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 <br />10/16/2017 <br />F 209 464-0138 � www.sicehd.com <br />