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SAN JOAQUIN i.Y —COUNTYEnvironmental Health Department ` '` Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: XU'K CONSTRUCTION Facility Ad5/ Aro Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring# 6 Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: I is Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Joh&v 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 37 SAMPLING AWVE-GRocnyo CHRMTY-sox Holding Temperature: coWLEMN cot,PLETioN Method: G=r)d Surf=* Screening Method: gran Verified Chain of Custody: ❑ Yes ❑No ft. N. SPOILS 8. _ Contamination Noted: El Yes ❑No r If yes, spoils storage Location: sbttpd = s sac^an Covered: ❑ Yes ❑Na If yes, material: x GROUTING or DESTRUCTION Total Depth: =_ Depth to Water: ft• '- tt- Grout Material: Ne it Cevmvul MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑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 ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas Ralf 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 s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 10 20 4 20 40 4 25 5 25 50 s is 15 30 30 60 6 17.5 35 7 7 35 70 70 7 ✓/ �`('/� 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com