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SAN 10AQUIN <br />COUNTY <br />�rentness grows Flew'.. <br />Date: �/ r �(Z Z <br />Facility Address: <br />Well Address: <br />W P# �% (� � <br />Soil Boring#: <br />Drilling Company: _ <br />Driller Onsite: <br />Consultant: � t:,c <br />Geologist: <br />Environments! �iasG�G� ©apartment <br />Mon' itoring Well/Soil Boring Inspection Report <br />Inspector: V �" G�� CONSTRUCTION <br />� �• �Sc�tf.� .,,SCK <br />Well#: ���� <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 />I:y7�l�C�l <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />0 �. <br />Total Depth: <br />�� Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: ,� � 1 �G`' �'�- <br />Depth to Water: ��. G � <br />Grout Material: C' �-� � e -n Q-'''�� <br />Gallons of Grout Used: G �(�'(' � � . <br />❑Well Installation Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie ❑Other: <br />��� <br />Water <br />allons <br />Cement 471b <br />Bags <br />�% Mix <br />+/Yater <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />4.7 <br />Thickest <br />Thinnest <br />Bags <br />Z.5 <br />5 <br />1 <br />S <br />10 <br />1 <br />S <br />10 <br />2 <br />_ <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 />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 />3 <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />• e i►.� � <br />�o�'�`� <br />��� ��� <br />:. - <br />►- .. <br />�. - <br />�. <br />� .. <br />`/`/. ���� <br />1►t�f <br />ft. <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 />_ <br />�= <br />�� <br />— <br />:�;: <br />s!a ttQd <br />� r <br />— <br />- <br />aeon,:. <br />�: <br />— <br />�: <br />S': <br />n <br />.. <br />�:� <br />— <br />.' <br />it, <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 />..�: �s <br />Screen <br />n. <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. Hazelfion Avenue � Sfiockfion, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com <br />