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SAN_-JOA0UIN Environmental Health Department —COUNTY— Greotness gron's fere. Monitoring Well/Soil Boring Inspection Report Date: `o ,v11 J Inspector: YA, CONSTRUCTION Facility A dress: z Well Address: Total Depth: WP# 01)3"�j-1 Well#: Drilling Rig Type: Soil Boring#: Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No 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: neigrit SAMPLING ABOVE-GSOUND Holding Temperature: COWFLErION CL7sMPLETicr4 Method: C3rovnd Surixe Screening Method: or� Verified Chain oI Custody: ❑ Yes ❑No ft" ft. ft. SPOILS Ze Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Covered: ❑ Yes ❑No If yes, material: =_ GROUTING or DESTRUCTION Total Depth: 04 _ Depth to Water: T. '6� Grout Material: e�- _AA- Gallons of Grout Used: —300MATERIALS/DEVELOPMENT Casing Type: [V ell 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 5K're mie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallf ons 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 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 v� - 15 30 6 30 1 60 6 17.5 35 7 35 1 70 7 20 40 B 40 1 80 8 ,U,19 Hz o 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 www.sicehd.com