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SAN JOAQUIN <br />---COUNTY-- <br />Gr-eot+less groes fere. <br />Date: �' �� <br />Facility Address: <br />Well Address: 1�'� <br />W P# <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 />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 ❑No <br />❑ Yes ❑No <br />❑ Yes ❑ No <br />❑ Yes ❑No <br />�I <br />GROUTING or DESTRUCT -ION- -Total Depth: - � - <br />Depth to Water: e 1 G t,;,;r'�ir <br />Grout Material: � <br />Gallons of Grout Used: `� �t t� Yl�i'1(`f <br />❑Well Installation <br />❑Well Destructiony- <br />❑Boring Installation�Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />Gravity ❑Tremie._ ❑Other: <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 />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION <br />❑ Stove Pipe ❑Christie Box <br />f� ,' ` f���r j` <br />:. -. <br />�- :. <br />.. <br />�. <br />� .. <br />r <br />�w <br />ft. <br />Cement 4?Ib <br />ea s <br />§% Mix <br />Water <br />allons <br />Cement 941b <br />ea s <br />Thickest <br />Thinnest <br />ttg <br />2.82 <br /><< <br />Thinnest <br />#Bags <br />2.5 <br />s <br />1 <br />s <br />A3 <br />_ <br />s <br />10 <br />2 <br />10 <br />20 <br />ti.. <br />?.5 <br />15 <br />3 <br />as <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 />1?.5 <br />35 <br />? <br />35 <br />70 <br />? <br />40 <br />80 <br />$ <br />20 <br />40 <br />8 <br />..:.i- <br />sac�en <br />_— <br />.,� <br />. <br />- <br />�. <br />- <br />- <br />�� <br />— <br />.� <br />_,,,, <br />_.... <br />it. <br />� <br />— <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />�(�.�, � Blank Feet <br />J 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 />Water <br />allons <br />Cement 4?Ib <br />ea s <br />§% Mix <br />Water <br />allons <br />Cement 941b <br />ea s <br />Thickest <br />Thinnest <br />ttg <br />2.82 <br />Thickest <br />Thinnest <br />#Bags <br />2.5 <br />s <br />1 <br />s <br />10 <br />1 <br />s <br />10 <br />2 <br />10 <br />20 <br />2 <br />?.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 <br />60 <br />6 <br />1?.5 <br />35 <br />? <br />35 <br />70 <br />? <br />40 <br />80 <br />$ <br />20 <br />40 <br />8 <br />m <br />q <br />m <br />s <br />c <br />a <br />C <br />•-• � - - <br />Screen <br />tt. <br />Feet <br />BentanitefGement Mix <br />3% Mix <br />§% Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <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 />