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SAN JOAQUIN <br />COU NTY-- <br />Greatness yraws lien_. <br />Date: � 1 <br />Facility Address: y <br />Well Address: <br />W P# C�(� <br />Soil Boring#: �= <br />Drilling Company: _ <br />Driller Ons'+�• <br />Consultant <br />Geologist: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <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 />cpnn c <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 0�— <br />Grout Material: <br />Gallons of Grout Used: '� <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation�oring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />I�ravity ❑Tremie ❑Other: <br />( �� <br />�� <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length From: To: <br />r <br />Filter Pack From: To: <br />- Bentonite From: To: <br />Grout From: To: <br />COMPLETION ❑Stove Pipe ❑Christie Box <br />s�rater <br />allons <br />Cemen 471b <br />Bag <br />S°I° It+llix <br />YVater <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />riBags <br />4.7 <br />Thickest <br />Thinnest <br />ttBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <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 />^a5 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />8 <br />,� J,S � S <br />1868 E. Hazelton Avenue � Stockton, California 95205 � <br />� i� � <br />� �� ;j <br />:. -. <br />� �. <br />«. <br />�- :. <br />.. <br />�� <br />ft. <br />:� <br />S°I° It+llix <br />Bentonite per 47 Ib <br />- <br />2.47 <br />Bentonite per 94 Ib <br />2.82 <br />4.7 <br />..,- <br />— <br />— <br />.>,. <br />;� <br />_ <br />�:= <br />sbti�d <br />— <br />s�on.�� <br />_ <br />:�: <br />_ <br />�, <br />���,� <br />— <br />�� <br />�-�` <br />— <br />a: <br />— <br />'� <br />ft. <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 />ft. <br />Feet <br />Bentonite{Gement IVlix <br />3°�° 11Aix <br />S°I° It+llix <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 />T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />