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Date: <br />Facility Address:_ <br />Well Address: <br />WP# A0-3 <br />Soil Boring#: <br />Drilling Company: _ <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: CONSTRUCTION <br />Total Depth: h <br />�'4 3 Well#:.fes 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 />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 />❑ Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total De th:_ 5 <br />Depth to Water: 01 S <br />Grout Material: <br />Gallons of Grout Used: 3; <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation'XBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />%Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />SKJOAQUIN <br />r4 <br />Water <br />gallons <br />L. <br />COUNTY <br />Thickest Thinnest <br />Greatness grows fere. <br />Date: <br />Facility Address:_ <br />Well Address: <br />WP# A0-3 <br />Soil Boring#: <br />Drilling Company: _ <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: CONSTRUCTION <br />Total Depth: h <br />�'4 3 Well#:.fes 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 />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 />❑ Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑ Yes El No <br />SPOILS <br />Contamination Noted: ❑ Yes El No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />❑ Yes ❑No <br />GROUTING or DESTRUCTION Total De th:_ 5 <br />Depth to Water: 01 S <br />Grout Material: <br />Gallons of Grout Used: 3; <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation'XBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />%Gravity ❑Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />ttBags <br />Thickest Thinnest <br />NBags <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 />15 <br />30 <br />6 <br />30 1 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 1 <br />70 <br />7 <br />20 <br />40 <br />8 <br />4C 1 <br />80 <br />8 <br />ft. <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 Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />//�(� I��v`� r�� �S 10/16/2017 <br />18681 E_. Hazelton Avenue ockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.swcehd.com <br />