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SAN J OAQ U I N Environmental Health Department COUNTY--- Greatness OUNTY—Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date:tZ//ff r/B Inspector: CONSTRUCTION Facility Address: 41SLc o 1!2&_ Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: °� Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes 11 No Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist:�/ GL Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING AWi VE.rppUNp _ Holding Temperature: COMPLETION c�rnoN Method: G=nd Sud=* Screening Method: grout Verified Chain of Custody: ❑ Yes El No ft. tt. SPOILS ; Fk = o Contamination Noted: ❑ Yes ❑No = r If yes, spoils storage Location: sacdan Covered: ❑ Yes ❑No = gravelpack If yes, material: GROUTING or DESTRUCTION Total Depth: ZDV . Depth to Water: 17 n• n' Grout Material: tVM e-LOAe� Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: XPressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity XTremie ❑Other: Type of Method: Wate C ent 4 Water Cement 941b allons Bas gallons Bags Thickest Thinnest 4Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 3%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 S Y-50 ! 10/16/2017 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-34201 F 209 464-0138 www.sicehd.com