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A. <br />SAN JOA UIN <br />—COUNTY ---- <br />Greatness grows fere <br />Date: holt In <br />Facility ddress: A <br />Well Address: <br />WP# D 6 <br />Soil Boring#: t� I . <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public <br />Public Water System Onsite <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />ector: CONSTRUCTION <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Well#: <br />2 - <br />xlr0.clo�) Total Depth: <br />Drilling Rig Type: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Verified Chain of Custody: ❑ Yes L1 No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑ No <br />Min 2" Annular EHD Seal Verified: ❑ Yes El No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />ABOVE -GROUND ctW1.m-BOX <br />COMFLErION COMPLETION <br />Ground surface <br />grout <br />ft. <br />n. <br />ft. <br />_ a <br />slotted <br />$scion <br />= Qraxel pads <br />GROUTING or DESTRUCTION Total Depth: l D !.51 '0l 15-1 <br />=_ <br />Depth to Water: 3 5 / —� fL tt <br />Grout Material: ajMQ .MATERIALS/DEVELOPMENT <br />Gallons of Grout Used: !Z70 ? eA <br />1 g Type: <br />Casin T e: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation*oring Destruction Slot Size: <br />Bags of Cement: <br />METHOD USED Bags Sand/Gravel: <br />❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />rA Gravity ❑Tremie ❑Other: Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />?t 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 />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 />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 />