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SAN JOAQUIN Environmental Health Department C" `) —COUNTY Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 43 Iti Inspector: CONSTRUCTION Facility Address: �d ,t Well Address: Total Depth: WP# DOMO i Well#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes []No Drilling Company: Carfmc4D Driller Onsite- Screen Screen Length From: To: Consultant:_JQ� Filter Pack From: To: Geologist:_�xu RP Bentonite From: To: �i I � 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 AWVE.GR0UND Holding Temperature: cowLET10N CoMP�LEnoN Method: Ground Suiacs Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No -�--n• fi. ft. SPOILS Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: atoned ' _= &aeon Covered: ❑ Yes ❑No = . — g-vat pack If yes, material: ` GROUTING or DESTRUCTION Total Depth: Depth to Water: • — n• Grout Material: Nutt ceweof MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet El Boring Installation ❑Boring Destruction Slot Size: 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 Rallons Bags Thickest Thinnest ttBags 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 3 10 20 4 20 40 4 12.5 25 5 25 50 5 T 15 30 6 30 60 6 .— . . 17.5 35 7 35 70 7 20 40 8 40 80 8 -` lG�v k w —" t�tCh 2 ✓ �� ' _l J •J10/16/2017�, 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 I F 209 464-0138 1 www.sicehd.com