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° I= SAN JOAQUIN Environmental Health Department —COUNTY— Monitoring Well/Soil Boring Inspection Report Date: ` Z t Inspector: CONSTRUCTION Facility Address:zytS? 1`f n V4 Well Address: Total Depth: 30 U'[-G WP# Well#: Drilling Rig Type: lKtAA vv�cr-f Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Screen Length From: -7.&* To: ZZIry Driller Onsite: My Consultant: Filter Pack From: vaL To: * .-4 Geologist: °�„ite— From:_0 To: Lo2 ?4, Grout From: 0 To: to Z Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑NoT casing If yes, location and distance: height SAMPLING �yE.GR ND _ Holding Temperature: COWLETION COMPiEMON Method: Or ound Svlac+ Screening Method: I P" grout Verified Chain of Custody: ❑ Yes ❑No �ft. tt. ft. SPOILS = Contamination Noted: ❑ Yes ❑No — If yes, spoils storage Location: siattnd = . saccan — Covered: ❑ Yes 11 No Ei If yes, material: GROUTING or DESTRUCTION Total Depth: _ =_ Depth to Water: • tt. Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: E<ell Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: El 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 ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas allons Bags Thickest Thinnest 9Bags Thickest Thinnest 4Bags Bentonite/Cement MIX 3% MIX 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 2 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 I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.sicehd.com