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SAN JOAQUIN Environmental Health Department COUNTY- Greatness grows her Monitoring Well/Soil Boring Inspection Report pie Date: X007- /Ll Inspector: IVA6- -- CONSTRUCTION 7 Facility Address: Sar+ 7`'Y y,4-t cb U Well Address: Total Depth: c— WP# "o %3VU Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No Drilling Company: 14 tv Driller Onsite: 4tjS/r, Screen Length From: To: Consultant: Filter Pack From: To: Geologist: T"OBentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height SAMPLING naovE-GROUND Holding Temperature: COWLETION COOMPtEnON Method: G mnd Surfacs Screening Method: arr n Verified Chain of Custody: ElYes ❑No —`---ft ft. ft. SPOILS = Contamination Noted: ❑ Yes ❑No = If yes, spoils storage Location: aacon = B Covered: ❑ Yes ❑No g-vw Pack If yes, material: GROUTING or DESTRUCTION Total Depth: �� Depth to Water: P 33 n• 2 — ft Grout Material: *vere Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Size: El Boring Installation 'Boring Destruction Bags Slot Siziz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ,Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity IpTremie ❑Other: Type of Method: Water ent 471b Water Cement 941b gallons Bas allons Ba mi Thinnest #Bags Thickest Thinnest tJBags 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 (� 3) 10/16/2017 18681 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com