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��� -� SAN 10AQUIN <br />�����."; -COUNTY <br />'� -, 1 <br />r <br />�r�[it=c�r`P Gr-eutr�rss �ro,rs h�rc>. <br />_._.. � <br />Date: � � � S 2� <br />Facility Address: <br />Well Address: <br />WP# `� f��,o� <br />Soil Boring#:. <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Environmental �lealth Departm <br />Monitoring Well/Soil Boring Inspection Repo <br />Inspector: c�c����c.�,J CONSTRUCTION <br />)r'� i -t 3Bo <br />9� _ Total Depth: <br />-�6c�-; ��� e #: Droning Rig Typ� <br />-��� �T� d � AOc,o1-5C� o-r��, �� 1 „���� v <br />.- . � Mln 2 Annular E <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 />Covered: <br />If yes, material: �,i'u� <br />GROUTING or DESTRUI <br />Depth to Water: G(' <br />Grout Material: <br />Gallons of Grout Used: <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑Yes ❑No <br />❑ Yes ❑ No <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation .Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity [�.Tremie ❑Other: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />i �/til <br />Seal Jerified: <br />JT �JG Q <br />❑ Yes ❑ <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />i ie► � <br />��/� <br />_. -. <br />�- _ . <br />.. - <br />i <br />�. <br />.. �, <br />��� <br />ft. � _ <br />���; _ <br />;� — <br />�M! <br />sbttQd ;: _ <br />soon �� = <br />��; _ <br />n�� .. <br />� yIZ�( a <br />ft. <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 />Water <br />allons <br />Cement 471b <br />Bas <br />5% Mix <br />+dater <br />allons <br />Cement 941b <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 />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 />r� <br />a <br />m <br />C <br />Q <br />Screen <br />��b� <br />�.�er, <br />». � r�z ba. <br />ti. <br />N ���� �� � <br />.l <br />��2��� . � <br />Feet <br />Bentonite/Gement 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 />