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SAN JUAQUIN Environmental Health Department ' —COUNTY— Greatness grows here. l Monitoring Well/Soil Boring Inspection Report Date: I /� Inspector: 0'fI D- !I - CONSTRUCTION Facility Address: '60 100 5- i r Well Address: Total Depth: WP# 00"3,815-0 Well#: Drilling Rig Type: Soil Boring#: — g 61 y Min 2 Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: ijec ' Driller Onsite: AM Screen Length From: To: Consultant: CO Filter Pack From: To: Geologist: rlCj I 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 SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION COMPLETION Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes El No �ft. ft. ft. SPOILS Contamination Noted: ❑ Yes ❑No r If yes, spoils storage Location: slotted sec�on Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: El Boring Installation boring Destruction rr Bags of Cement: METHOD USED �' -rpr��j, s�i Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity *Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gallons Bas Ilons Bags Thickest Thinnest irBags 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 IS 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 1 60 6 17.5 35 7 35 1 70 7 20 40 B 1 40 1 80 8 l b 10/16/2017 9A abo-qS 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com