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SAN4JOAQUIP <br />--COUNTY- <br />grows here <br />Environrnet I Health Department <br />Public Water System O'nsite: El Yes El No <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: <br />ess: 2'15 <br />Well Address: <br /> <br />WP fri190°3790 Well#:SALL=StLS. <br />Soil Boring#: <br />Faci <br />Drilling Company. <br />Driller Onsi <br />Consultant: <br />Geologist: fig,t„..e.- :- <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: D Yes ONo <br />To: <br />To: <br />To: <br />To: <br />El Christie Box <br />From: <br />From: <br />From: <br />From: <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: 0 Yes IIINo <br />SPOILS <br />Contamination Noted: El Yes GA <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION:Iptal Depth: ic ( 42.41-C-1. S <br />Depth to Water: -7 / • <br />Grout Material: tie.ick <br />Gallons of Grout Used: <br />. DWell Installation D.Well Destruction <br />El Boring Installational. oi4?'-lr;Destruction <br />METHOD USED <br />ure Grout ElOver Drill OPresy <br />Gravity DTremie ' DOther: <br />Water <br />gallons <br />Cement 47 lb <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thfckest Thinnest 4 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 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Casing Type: <br />Blank Feet Screen 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 />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 />10/16/2017 <br />1868 E. Hazelton venuef Stoo ton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />easing <br />height <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION El Stove Pipe <br />D Yes 1=1No <br />CI Yes Wo <br />MATERIALS/DEVELOPMENT