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SAN_J 0 A Q U IN Environmental Health Department !' ` —COUNTY— _ Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 147 Inspector: L,,' kvo CONSTRUCTION Facility Address: CiSb I -M. Rel Well Address: Total Depth: WP#bD3ftD Well#: Drilling Rig Type: Soil Boring#: T „ Min 2"Annular EHD Seal Verified: El Yes ❑No DrillingCompany: ( a ,��u Sons jzc� Driller Onsite: Screen Length From: To: Consultant: �^ Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height T SAMPLING AovE-GROUND Holding Temperature: COMPLET10N CC,hWLETioN Method: Grwnd Surf=* Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No f' fi ft. t. SPOILS = Contamination Noted: ❑ Yes ❑No — e If yes, spoils storage Location: 21[4 ss�an — Covered: ❑ Yes ❑No If yes, material: _= GROUTING or DESTRUCTION Total Depth: ,0� Depth to Water: - ' Grout Material: lo-3 5-4,AL MATERIALS/DEVELOPMENT Gallons of Grout Used: / Casing Type: 8'Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity L?rremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gallons Bas gallons Bags Thickest Thinnest .Bags Thickest Thinnest #Bags Bentonite/Cement MIX 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 10' z 10 20 z Bentonite per 94 Ib 2.82 4.7 7,5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com