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SAN JOAQUIN • _' f� Environmental Health Department —COUNTY-- Greatness grows here. Monitoring Well/Soil Boring Inspection Re ort Date: p ZL if inspector: A/llftec— CONSTRUCTION Facility Address: z 193 Al-,"— Well Address: Total Depth: WP# Gt`�3'D 2-1 Well#: Drilling Rig Type: Aiic bD Soil Boring#: AS,- Q// Drilling Company: �a Min 2"Annular EHD Seal Verified: El Yes ❑No Driller Onsite: �QiB�f Screen Length From: To: Consultant: ?�/�a/ Filter Pack From: To: eo- 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: I T height T SAMPLING ABOVE-GROUND Holding Temperature: cot. LETION cOMPLEX Mi Method: Ground Surf=* Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �ft. ft. ft. SPOILS = o Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: atottQa sicdon Covered: ❑ Yes []No If yes, material: '< GROUTING or DESTRUCTION Total Depth: Depth to Water: nV G e n' n' Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: []Boring Installation XBoring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie )Wther: 'fNtIGee Type of Method: ter ent 4 1 Water Cement 941b gallons Bas gallons Bags Thic hinnest 1r Bags Thickest Thinnest sBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 5 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 1 35 1 70 7 20 40 8 1 40 1 80 8 X& to 10/16/2017 YO 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.sicehd.com