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/CL <br />Ve_ <br />is Well#: <br />Yes lilNo <br />Yes ON° <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />SANIJOAQUIN ) COUNTY <br />• ao4S2e'-r/ \-4,11.,Fore7,,x;•• ,,reotness grows here <br />Date:L1 <br />Facility Address: <br />Well A dr(540. <br />WP# <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Inspector: <br />S • <br />Screen Length <br />--rt_dinrcf,) Seral,ter Pack <br />entonite <br />Grout <br />Min 2" Annular EHD Seal Verified: E Yes EINo <br />To: <br />To: <br />To: <br />To: <br />Monitoring Well/Soil <br />Environmental Health Department <br />Boring Inspection Report <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />From: <br />From: <br />From: <br />From: <br />/4 3 <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: CI Yes D No <br />SPOILS <br />Contamination Noted: I=1 Yes EINo <br />If yes, spoils storage Location: <br />Yes nNo <br />EWell Installation EWell Destruction <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />'Dirt Y - Kif) CA_ ±ect <br />20 40 8 40 80 8 <br />tA//0 I <br />ll$C-eiVDI <br />S e <br />0 <br />e <br />- <br />“CLkize4 Lt <br />9 10/16/2017 <br /> <br />1868 E. Hazelton Avenue I Stbrckton, California 95205 I T 209 468-3420 I F 209 44-0138 I wwV.sicehd.com <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: IS <br /> <br />Depth to to Water: <br /> <br />Grout Material: <br />Gallons of Grout <br />El Boring Installation <br />METHOD USED <br />EPressure Grout DOver Drill <br />i=1 - tin .44 <br />Used: S <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />oring Destruction <br />C-a v\--eic-cL,{" Screen Feet <br />?Cc ravity ETremie DOther: <br />Water <br />gallons <br />Cemerc_7IbD Water <br />gallons <br />Cement 94Ib <br />Bags Bag <br />Thickest Thinnest 0 Bags Thickest Thinnest 4 Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 s <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />COMPLETION 111 Stove Pipe EChristie Box <br />casing <br />height <br />CI-EFIISTY-BOX <br />COMPLETION