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SAN.: JOAQUIN <br />---COUNTY-- <br />Greatness grows Mere. <br />Date: 6 2 1 <br />Facility Address: � <br />Well Address: <br />Soil Boring <br />Drilling Col <br />Driller Ons <br />Consultant <br />Geologist: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Insaector: <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 />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />GROUTING or DESTRUCTION Total Depth: <br />Grout Material: � - <br />Gallons of Grout Used: 1 Dlall i <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation,�l,Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �Tremie ❑Other: <br />❑ No <br />❑No <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑Yes ❑No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION <br />Water <br />allons <br />Cement 471b <br />ea s <br />5°I° Mix <br />YVater <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />ti Bags <br />2.82 <br />Thickest <br />Thinnest <br />#Bags <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 />S <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <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 />aac�cn <br />40 <br />80 <br />8 <br />❑ Stove Pipe ❑Christie Box <br />tt. <br />3°,�° Mix <br />5°I° Mix <br />Bentonite per 4T Ib <br />1.41 <br />2.4� <br />Bentonite <br />per 94 Ib <br />2.82 <br />4.7 <br />aac�cn <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 />BentonitefGement Mix <br />3°,�° Mix <br />5°I° Mix <br />Bentonite per 4T Ib <br />1.41 <br />2.4� <br />Bentonite <br />per 94 Ib <br />2.82 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sicehd.com <br />