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SAN 10AQUIN Environmental Health Department -COUNTY - Monitoring COUNTY -Monitoring Well/Soil Boring Inspection Report Date: 2/5/1°I Inspector: n✓+SE6v6-%. CONSTRUCTION Facility Address: I5'-1 () 'Arc�- PK,.4— Well Address: Total Depth: WP# vo 3!!1 Iloo Well#: Drilling Rig Type: Soil Boring#: 0 Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Tu beh Screen Length From: To: Driller Onsite: Consultant: /t." 41 Pr Filter Pack From: To: Geologist: Sa.tf 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: WT height SAMPLING A80VE-GROUND Holding Temperature: COWLETION ccomPLEncN Method: around Surfac* 'T Screening Method: alter Verified Chain of Custody: ❑ Yes ❑No —`---n' n. n. SPOILS = Contamination Noted: ❑ Yes ❑No = If yes, spoils storage Location: on — B Covered: ❑ Yes ❑No Q-V'w Pack If yes, material: _— F GROUTING or DESTRUCTION Total Depth: ,0 4- Depth to Water: /71 ft• n Grout Material: "e*'4eA.e,.-t MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction �� Blank Feet Screen Feet Slot Size: ❑Boring Installation ABoring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity MTremie ❑Other: Type of Method: at (e� 47 Water Cement 941b allo Ba Fallons Bags Thickest Thinnest uBags Thickest Thinnest rlBags Bentonite/Cement Mix 3% Mix 55% 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 1 35 70 7 20 40 1 40 80 8 -7 �Z 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com