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�.f:�pC:�'.. <br />SAN 10AQUIN <br />COUNTY <br />Grec,.,;ess grosys }sere. <br />Date: G� Z Z� <br />Facility Address: If;� <br />Well Address: <br />WP# � fit- _�Z <br />Soil Boring#: �_ <br />Drilling Company: <br />Driller Onsite: <br />Consultant <br />Geologist: <br />�.. <br />Monitoring Well/Soil Boring Inspection Report <br />.� <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: ❑Yes ❑ No <br />If yes, material: r � <br />GROUTING or DESTRUCTION Total Depth: �-' t Z-�j I <br />Depth to Water: <br />Grout Material: �� C�;V1�1�- <br />Gallons of Grout Used: <br />,'Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ❑Tremie <br />�l �� <br />i ,i),,I`� �' <br />� \' �,C� <br />V`/ V <br />❑Other: <br />Water <br />allons <br />Cement 471b <br />Bads <br />S% Mix <br />+Nater <br />allons <br />Cement 941b <br />Ba s <br />Thickest <br />Thinnest <br />#Bags <br />4.7 <br />Thickest <br />Thinnest <br />Bags <br />Z.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />S <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 />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 />35 <br />7 <br />40 <br />80 <br />8 <br />20 <br />40 <br />3 <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 ❑Stove Pipe ❑Christie Box <br />casing <br />height <br />�aovE-�RcuNo ct�:srY-aox <br />GCMPLEiK�N COMPLETION <br />t3ro�ind 5urfxa —••� <br />p rncrt <br />n. <br />it. <br />ft. <br />.�;_ <br />tia _ �� O <br />v� �' � <br />:�rm <br />0 <br />sbtwd yr _ � <br />'..-. __ S�� P� <br />�.. <br />�� — <br />�i _. <br />h, fi. <br />MATE RIALS/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 />Feet <br />Bentonite/Gement Mix <br />3% Mix <br />S% Mix <br />Bentonite per 4� Ib <br />1.41 <br />2.47 <br />Bentonite 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.sjcehd.com <br />