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SANRJOAQUIN <br />Greatness grows here. <br />Monitor' g II/Soi <br />Date: <br />5 Inspector: <br />Facility Address: lA <br />WP# q 0 f 7 Well#: Af <br />Soil Boring#: k C?f <br />Drilling Company: M k2 Vi 64%;n<l <br />Driller Onsite: <br />Consultant: VJPA,vFNcA-r <br />Geologist: k-4NkA-QTrJ <br />Public Water System Onsite: I Yes ❑No <br />Domestic Well Onsite: ❑ Yes �No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />wnn c <br />Contamination Noted <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:_ <br />Depth to Water: %>C 'b <br />Grout Material: <br />Gallons of Grout Used: `^ aj <br />❑Well Installation ❑Well Destruction <br />El Boring Installation /Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity �Tremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />eallons <br />Cement 94 ib <br />Bags <br />Thickest T <br />' est <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 <br />5 <br />1 <br />s 10 <br />1 <br />5 <br />19 <br />10 20 <br />2 <br />7.5 <br />15 1 <br />3 <br />15 30 <br />3 <br />10 <br />20 <br />4 <br />20 40 <br />4 <br />12.5 <br />25 <br />5 <br />25 50 <br />5 <br />15 <br />30 <br />6 <br />30 60 <br />6 <br />17.5 <br />35 <br />7 <br />35 70 <br />7 <br />2D <br />40 <br />8 <br />1 40 80 <br />8 <br />Environmental Health Department <br />Boring Inspection Report <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION ❑ Stove Pipe <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />ABOV =-dROU rn CHRZ r sox <br />COWLET)ON COMPLETION <br />Ground suctacs . + <br />grout <br />fi. <br />tt. <br />ft. <br />m <br />-= o <br />stoned <br />sae�on -_ <br />= sri+;� <br />fi. <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 />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />