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�`` SANr�:IOAQUIN <br />COUNTY <br />Greatness grows here <br />Date: l �-/(J✓ V <br />Facility Address:_ <br />Well Address. <br />WP# U� <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 />Ins ectors OL/Li <br />I j ►reqs r / <br />Well#: <br />e O <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 <br />❑ Yes ❑No <br />Verified Chain of Custody: ❑Yes ❑No <br />SPOILS <br />Contamination Noted: ❑Yes ❑No <br />If yes, spoils storage Location: <br />Covered. ElYes 11No <br />If yes, material: <br />GROUTING or DESTRU <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used. <br />C�] <br />Total Depth: <br />^ g C) <br />❑Well InstallationDestruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />rG <br />ravity <br />❑Tremie <br />Water❑Other: <br />Cement 47ib Water <br />(S' <br />Ar <br />gallons <br />Bas <br />3°�° Nii� <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />Thickest <br />Thinnest <br />#J 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 />r�iaria� <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 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />40 1 <br />80 1 <br />8 <br />20 <br />40 <br />8 <br />CONSTRUCTION <br />Y�1 <br />: <br />Drilling Rig Type. <br />Total Depth <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />m <br />From: <br />From: <br />Fro: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />#t, <br />�entonitefOement [Vli�c <br />3°�° Nii� <br />�% Nli� <br />a� <br />Bentonite per 94 Ib <br />2082 <br />4.7 <br />r�iaria� <br />soonL <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 />�1 <br />Screen <br />Feet <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.slcehd.com <br />�entonitefOement [Vli�c <br />3°�° Nii� <br />�% Nli� <br />Bentonite per 94 Ib <br />2082 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.slcehd.com <br />