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SAN JOAQUIR <br /> Environmee. l Health Department <br /> ---COUNTY— <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> 0 I/llnsp CONST <br /> ector: <br /> RUCTION <br /> Date: $ AV <br /> Facility Address: ks a Total Depth: <br /> Well Address: 9 Well#: 2 Drilling Rig Type: <br /> wP# 3 <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes No <br /> a Screen Length To: <br /> Drilling Company: th From: To: <br /> Driller Onsite: 6 l� Filter Pack From: <br /> S Bentonite From: To:� <br /> Consultant: <br /> Geologist: k Grout From: To: <br /> Public Water System Onsite: <br /> ❑Yes ❑No COMA Stove Pipe ❑Christie Box <br /> ❑Yes ❑No aaoinq <br /> Domestic Well Onsite: height <br /> If yes,location and <br /> distance: -� <br /> ABOVE•GROUNO CHgtM430X <br /> SAMPLING COWLET1ON commEfIGN <br /> Holding Temperature: ("' -- <br /> Method: °ram <br /> Screening Method: tt' <br /> „ <br /> Verified Chain of Custody: El Yes ❑No <br /> SPOILS Y <br /> ❑Yes ❑No ; SE <br /> Contamination Noted: swnaa 8 <br /> If yes,spoils storage Location: "clan ; <br /> ❑Yes ❑No = yravd pacts <br /> Covered: -- <br /> If yes, material: <br /> tt. <br /> GROUTING or DESTRUCTION Total Depth: � f� 35t� 3 tt. <br /> Depth to Water: , 0 ssaselc/DEVELOPMENT <br /> Grout Material: <br /> Gallons of Grout Used: Casing Type: Feet <br /> LSh Blank Feet Screen <br /> ❑Well Installation Well Destruction J slot Size: <br /> ❑Boring Installation Bags of Cement:oring Destruction Bags Sand/Gravel: <br /> METHS Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> Type of Method: <br /> ❑ Gravity 0Tremie ❑Other: <br /> Cement 941b <br /> Water Cement 471b Water Ba s <br /> Be s allons pBags BentonitelCern®Rt Mix M2�4!1.7y <br /> allons Thickest Thinnest NBags Thices B9nlOnitB er471bs 1 510 z <br /> 52. 10 20 <br /> 5 10 2 15 30 3 <br /> 7.5 15 3 40 4 <br /> 10 20 4 20 <br /> 25 50 5 <br /> 5 <br /> 1 5,dn \V 1•I" ` <br /> 12.5 25 5 30 60 6 �tltl//"uo'YY <br /> 15 35 70 7 <br /> 17.5 5 s 40 sB B �1 w 10/16/2017 <br /> 20 4U 6.liy,Q„ "t� <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209`4668-314420 1 FF 209 464-0138 1 wWW.si <br />