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SAN.IOAQUIN COUNTY Environmental Health Department kyr Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: �I 1 qI4 Inspector: 4 • CONSTRUCTION Facility Address: / r /),— b t I -r., 2 1 Well Address: Total Depth: WP# Ss 1 Well#: Drilling RigT e7 � n ,H Yp f�ST1 q � Soil Boring#: 5 Drilling Company +°r i Min 2" Annular EHD Seal Verified: ❑ Yes El No Driller Onsite: r L Screen Length From: To: Consultant: 0 L ✓h Filter Pack From: To: GeoBentonite 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 ABOVE-GROUND Holding Temperature: COMPLETION CCOOMPLEnoN Method: G=nd Surf=* Screening Method: groLn Verified Chain of Custody: ❑ Yes El No M tt. ft. SPOILS Contamination Noted: ❑ Yes El No If yes, spoils storage Location: slotted s�c0on _ Covered: ❑ Yes ❑No =_ g-vw s If yes, material: GROUTING or DESTRUCTION Total Depth:_ Depth to Water: i't GIN fL — ft. Grout Material: /V MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation'ZBoring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: 145 Filter Pack Type/Size: K Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas Rallons Bags Thickest Thinnest #Bags 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 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1866 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com