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�'� �=�� °� SAN JOAQUIN <br />�.: � - <br />�:� ;. ��' COUNTY---- <br />:;;- %' <br />-,:' f� <br />Cil"f'.Elfllt'.;S �!"045 t1Er� <br />Date: <br />Facility Address: <br />Well Address: _ <br />W P# � �� � <br />Soil Boring#: <br />Drilling ComK <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />pector• � <br />�w� <br />Well#: <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 />r;�•1r><� <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />Depth to Water��y vt <br />Grout Material: <br />Gallons of Grout Used: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Tot I De the i i <br />❑Well Installation ❑Well Destruction <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />_. <br />� i.� � <br />\ �� <br />:. -. <br />�- :. <br />.. - <br />�. <br />� % .. <br />/. <br />�.� <br />u V `►rv2i <br />❑Boring Installation ❑Boring Destruction �f,� <br />`���f <br />METHOD USED /� , <br />❑Pressure Grout ❑Over Drill `�/ <br />❑ Gravity ❑Tremie ❑Other: <br />�\ <br />Water <br />allons <br />ement 471b <br />Bas <br />5% Mix <br />Water <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />..##Bag <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 />35 <br />70 <br />7 <br />17.5 <br />35 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />it. <br />sbttpd <br />wc�on <br />MATERIALS/DEVELOPMENT <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 />��' ; <br />Screen <br />Feet <br />BentonitelCement Mix <br />3% Mix <br />5% Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />