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�AN:JOAQUIN <br />COUNTY <br />Greetrrtss {ra„s hire. <br />Date: 5t ' /22 <br />Facility Address:_ <br />Well Address. <br />WP# 0 <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />environmental Health Department <br />Monitoring Well/ Boring Inspection Report <br />Inspector: 'S t' I CONSTRUCTION <br />�g6 L• ?�� �� S�I�.✓ <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />G -- <br />if yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />T <br />yes, material: <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 />❑ Yes ❑No COMPLETION <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑Yes ❑ No <br />u / <br />GROUTING or DESTRUCT <br />Depth to Water: YO d —– <br />Grout Material: LCG t cen�^�`�` <br />From: To: <br />From: To. <br />From: To. <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />7W + <br />WULTRDN <br />GmK,,rxf Sw-1acs <br />prrxri <br />f” <br />f#. <br />Q <br />SOLOr <br />gas <br />�°!° Mix <br />¢allons <br />Cement 941h <br />Bats <br />Thickest <br />Thinnest <br />9 Bags <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 />.- <br />20 <br />4 <br />�. <br />40 <br />4 <br />125 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />SH <br />30 <br />60 <br />6 <br />17,5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />r <br />_sst <br />u: <br />Gallons of Grout Used: � UMATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation Nell Destruction SSI Blank Feet Screen <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />�7 Gravity �Cremie ❑Other: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />Type of Method: <br />Water Cement 471b Water <br />oallons <br />gas <br />�°!° Mix <br />¢allons <br />Cement 941h <br />Bats <br />Thickest <br />Thinnest <br />9 Bags <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 />125 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />b <br />30 <br />60 <br />6 <br />17,5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 <br />40 <br />8 <br />40 <br />80 <br />8 <br />Slot Size: <br />Feet <br />10/16/2017 <br />1808 E. Hazelton Avenue � Stockton, California 95205 (T 209 468-3420 (E 209 464-0138 (www.sicehd.com <br />�entonitef�ement Mix <br />�°!° Mix <br />�°�° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2082 <br />4.7 <br />10/16/2017 <br />1808 E. Hazelton Avenue � Stockton, California 95205 (T 209 468-3420 (E 209 464-0138 (www.sicehd.com <br />