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n�iN co 111P _ZJ SAN J OAQ U I N Environmental Health Department —COUNTY— SI OUNTY— `ALIFO r Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: �J_a Inspector: CONSTRUCTION Facility A dress: P2scaz-t-o P-+t ,[IZ" Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: I evn Drilling Company: (Yl�L� ' Min 2" Annular EHD Seal Verified: ElYes El No Screen Length From: To: Driller Onsite: Consultant: Prv?? Gbl n. Filter Pack From: To: Geologist: 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 ++ T SAMPLING ABOVE-GROUND Holding Temperature: COWFLETION COMPLETION Method: Ground Surfa t Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �ft. it. ft. SPOILS Contamination Noted: ❑ Yes El No a` If yes,spoils storage Location: slotted _ B sacdon Covered: ❑ Yes ❑No gr,,,s, Pack If yes, material: GROUTING or DESTRUCTION Total Depth: 1� � Depth to Water: I�� rS dfYC 1tft ft. n" Grout Material: QI if U ___ MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ` Slot Size: ❑Boring Installation Loring Destruction Bags of Cement: METHOD USED t Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471h Water Cement 941b allons Ba allons Bags Thickest Thinnest tlBags 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 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 1 1 30 30 0 6 17.. 7 7 5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com