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SAN JOAQUIN Environmental Health Department <br /> cirri,..= <br /> Greatness grows hefc <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: ( CONSTRUCTION <br /> Facility Ad re s: 62L OV7A44 <br /> Well Address: Total Depth: <br /> WP# f j)q?2f'7�7 Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: -'Fri CoLm" OCA <br /> Driller Onsite: LU( 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 El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING AsovE-GaouNo CHR_ <br /> Holding Temperature: cOWLETX:)N coMPLET11ON <br /> Method: Ground surf"' <br /> Screening Method: or«rt � (� <br /> Verified Chain of Custody: ❑ Yes El No -j=, n' L <br /> tt. <br /> n. — 2 <br /> SPOILS : <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: atoned <br /> section — B <br /> Covered: ❑ Yes El No ' <br /> 9-61 pacK <br /> If yes, material: <br /> y <br /> GROUTING or DESTRUCTION Total Depth: P <br /> �- _ %� <br /> Depth to Water: / ("v n- tt' <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> Well Installation []Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> .Pressure Grout ❑Over Drill ��� „p Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity jZlTremie ❑Other: l � Type of Method: <br /> Water Cement 471b Water ment 941b <br /> allons Bas allons Ba s <br /> Thickest Thinnest uBags Thickest Thinnest b6 Bentonite/Cement Mi ° o Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2. 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />