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• SAN JOAQUIN <br /> Environmental Health Department <br /> ' —`oJNT', <br /> Grertnes; gro+.s here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 1 YBeA CONSTRUCTION <br /> Facility Address:TO 6 r V?Atn/iL,,k- p <br /> Well Address: Total Depth: <br /> WP# bb3 0 WQell#: Drilling Rig Type: <br /> Soil Boring##: _ b'" 6-1Z) <br /> Drilling Company: rij-2- Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No Cas Ing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETION COr.+LE71CN <br /> Method: around Surface <br /> Screening Method: gran <br /> Verified Chain of Custody: ❑ Yes El No <br /> n. <br /> n. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: <br /> .�ccn <br /> Covered: ❑ Yes ❑No = ,w,A;.a- <br /> If yes, material: rr <br /> GROUTING or DESTRUCTION Total Depth:_��t _= <br /> p No- n n. <br /> Depth to Water: W <br /> Grout Material: cetY�-t7 <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> []Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation�Boring Destruction <br /> // Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity ❑Tremie ❑Other: Type of Method: <br /> water '_ement 471b water lenient 94Ib <br /> allons ORS ^allons Bags <br /> Th ckest Thinnest :Bags 'hici.est Thinnest 9Bags Bentonite/Cement Mix 3% MIX 5% Mix <br /> 2.5 1 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 2 10 20 Bentonfte per 94 Ib 2.82 4.7 <br /> �.5 15 3 15 30 <br /> ILI .0 <br /> 121 25 25 50 5 1~ 'J /� C I. f/ S (�u.j W ( vV Q r <br /> 1'. 30 30 e0 i (i JJ J VV J <br /> 1;-5 35 - 3s .o 7 <br /> 2u 40 6 40 60 b <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 www.sicehd.com <br />