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QUI/y <br />° C% SAN JOAQUIN <br />-` COUNTY <br />Greatness orows here. <br />Environmental Health Department <br />Monitoring well/ )oil Boring Inspection Report <br />Date: �� ��pector: 1✓I�Yi O- a CONSTRUCTION <br />Facility Address: ���±1 c ay�• <br />Well Addresse <br />WP# O �j Well#: <br />Soil Boring#: s V 5V 96�5 <br />Drilling Company: �,,i�ALoon <br />Driller Onsite: <br />,00 <br />Consultant. YO�L� <br />Geologist: ,pk4 <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 />Sv <br />Covered: ElYes ElNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: ` <br />Depth to Water: lel JI�- <br />Grout Material: <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />:]Boring InstallationK13 <br />oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Dril <br />ravity <br />❑Tremie <br />Water <br />❑Other: <br />allons <br />Cemen 471b <br />Bas <br />�°�° Mix <br />Water <br />allons <br />Cement 941b <br />Ba s__ <br />Thickest <br />Thinnest <br />#Bags <br />4.7 <br />Thickest <br />Thinnest <br />rieags <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 />1 30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />25 <br />50 <br />5 <br />12.5 <br />25 <br />5 <br />30 <br />60 <br />6 <br />15 <br />30 <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 />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 />COMPLETIONI ad <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />❑ Stove Pipe ❑Christie Box <br />:. <br />VWLETION COMPLETION <br />- <br />grout <br />`V <br />CX3. <br />I—Sv3 s���43)1ort2d <br />sac9on <br />tt. <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 />tt. <br />Feet <br />BentonitefCement Mix <br />3°�° Mix <br />�°�° Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />1868 E. Hazelton Avenue Sto ton, California 95205 T 209 468-3420 F 209 464-0138 www.sicehd.com <br />