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SAN JQAQUIN <br />COUNTY <br />Greniness gro;vs here. <br />Environmental) HealtG� o��C��rtment <br />Monitoring Well/Soil Boring Inspection Report <br />C��c��ZZ --11��. � <br />Date: Inspector: U � � CONSTRUCTION <br />Facility Address: <br />Well Address: © �� <br />WP# (����� � � Well#: <br />Soil Boring#: � <br />Drilling Company: '"� e r <br />Driller Onsite: <br />Consultant: _(� � G sy �^ fi�L <br />Geologist: �)�11N1 ,�C1� �/1( r�l <br />Public Water System Onsite: <br />�� <br />❑ Yes ❑ No <br />Domestic Well Onsite: ❑Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: ❑Yes ❑No <br />SPOILS <br />Contamination Noted: ❑Yes ❑ No <br />If yes, spoils storage Location: <br />Covered: ❑Yes ❑ No <br />Total Depth: � U <br />Drilling Rig Type: _ <br />MG,o� �Zc���tr <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: <br />From: <br />From: -3d � <br />From: I S <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />/ i <br />To: [ c� <br />To: 1 <br />�ristie Box <br />it � � �` <br />�� <br />:. -. <br />►- .. <br />�. - <br />C <br />.. <br />//. <br />�iiiW - <br />ft. <br />sbtc�d <br />a�cn <br />If yes, material: ��1l.^, <br />GROUTING or DESTRUCTION Total De the c�/. 1 S / � /� YG��" <br />p <br />Depth to Water: �J/ � <br />Grout Material: %ie(.�I �� Gc�,l� ��r <br />Gallons of Grout Used: �� o � 0 � i <br />�1Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />�% 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 />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 />$0 <br />8 <br />20 <br />40 <br />8 <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 />Bentonite/Gement 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 />~.8:. <br />V' <br />.�� <br />'�r <br />�::�. <br />�'' <br />4 <br />. <br />.�; <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 />Bentonite/Gement 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 />10/16/2017 <br />1868 E. Hazelton Avenue � Stockfion, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />