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S A N rd OAQ U I N <br />COUNTY <br />�•' Greolness grows hero. <br />)ate,0 <br />)011(51 <br />Facility Address: cS <br />Well Address: <br />W P# Z <br />Soil Boring#: <br />Drilling Comoanv: <br />Driller nsit <br />Consultant: <br />Geologist: Y S C L <br />Environmental Health Department <br />cas�.ng <br />height <br />, 0 - Eit�±L Tflfl <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector:%cK/ CONSTRUCTION <br />Well#: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />[f yes, location and distance: <br />SAMPLING <br />Holding Temperature. <br />Method: <br />Screening Method: <br />Verified Chain 1P <br />SPOILS <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />C,� Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑Yes ❑No <br />If <br />Contamination Noted: ❑Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes El No <br />If <br />yes, material: <br />GROUTING or DESTRUCTfON <br />Depth to Water: lnj— (Cr - " <br />Grout Material. % 1�J1Lo�t c �-- — <br />Gallons of Grout Used: �- �/ SLI r2i <br />❑Well Installation /ell Destruction <br />:]Boring <br />Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />`gravity ❑Tremie ❑Other: <br />Water Cement 47 ib WaterCement 941b <br />allons Bas 11 <br />From: To: <br />From: To. <br />From: To: <br />From: To: <br />COMPLETION ❑ Sfiove Pipe ❑Christie Box <br />C44USTYSOX <br />GOrvw� COMPLETION <br />Grodnd Suriacs <br />grout <br />ft. <br />t�. <br />tt, <br />slottad <br />Q� <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 />Screen <br />Feet <br />�entonitef�ement I�I(ii�€ <br />3°l6 lirli� <br />�8�� [�ti� <br />Ba s <br />Thickest <br />Thickest <br />Thinnest <br />ft Bags <br />Thickest <br />Thinnest <br />#Bags <br />Uentonite per 94 Ifs <br />2082 <br />5 <br />10 <br />2 <br />10 <br />20 <br />2 <br />7.5 <br />15 <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 />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />From: To: <br />From: To. <br />From: To: <br />From: To: <br />COMPLETION ❑ Sfiove Pipe ❑Christie Box <br />C44USTYSOX <br />GOrvw� COMPLETION <br />Grodnd Suriacs <br />grout <br />ft. <br />t�. <br />tt, <br />slottad <br />Q� <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 />Screen <br />Feet <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockfion, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />�entonitef�ement I�I(ii�€ <br />3°l6 lirli� <br />�8�� [�ti� <br />Uentonite per 94 Ifs <br />2082 <br />4.7 <br />t <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockfion, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />