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SANJOAQUIN Environmental Health Department —COUNTY— Greatness grows here. �� o© Monitoring Well/Soil Boring Inspection Report 1PMwX 1YQ Date: f �� Inspector: CONSTRUCTION Fled � Facility Address: Well Address: N Total Depth: Wil/ WP# Well#: Drilling Rig Type: GmV lVl OE(��G Soil Boring#: 1 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No ` Drilling Company: Driller Onsite: Screen Length From: To: Filter Pack From: To: Consultant: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes 0 N COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height nT- SAMPLING ABCyE-GROUND _ Er Holding Temperature: COMPLXDN CCOMPLETlON Method: Ground SLrtaca Screening Method: cry Verified Chain of Custody: ❑ Yes []No ft- ft. ft. SPOILS J —_ Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: soccn Covered: El Yes El No w 2-tw>-ack If yes, material: I ' _ GROUTING or DESTRUCTION Total Depth: A =_ Depth to Water: ft n' ON Grout Material: m�T*A Gallons of Grout Used: MMRIALS/DEVELOPMENT Casing Type: LWell Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ressure Grout []Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie El Other: Type of Method: Water Cement 471b Water Cement 94 lb allons Bags gallons Bags Thickest Thinnest "Bags Thickest Thinnest #Bags Bentonite/Gement Mix 3% Mix 55% 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 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com