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SAN,JOAQUIN Environmental Health Department COUNTY Greatness grows here. 4 Monitorin/g� Well/Soil Boring Inspection Report Date/7 / A / Inspector: I I A `I CONSTRUCTION Facility Address: Well Address:1-4s9 I c Total Depth: WP# C& _')9S Well#: Drilling Rig Type: Soil Boring#: Drilling Company: /�,�� S /)"'111 � L'< Min 2" Annular EHD Seal Verified: El Yes []No Driller Onsite: L � cf � �// Screen Length From: To: Consultant: 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 SAMPLING ABOVEGROUND Holding Temperature: CO&FLEfION comps- BOX Method: Grmw4 Sudact Screening Method; GrOtA Verified Chain of Custody: ❑ Yes ❑No n' tL R. SPOILS Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: allotted aKJon — Covered: ❑ Yes El No gravel P..k If yes, material: I� GROUTING or DESTRUCTION Total Depth:'Z6S i f -A Depth to Water: n- — M Grout Material: 62Gfq to h,,''6— MATERIALS/DEVELOPMENT Gallons of Grout Used: VC 4a� Casing Type: OWell Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity [ATremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest BBags 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 X20 /O�j 12.5 25 5 25 50 5 c 15 35 7 35 70 7 30 6 30 60 6 / /n/ 17.5 20 40 B 0 40 8 �-1 „" �O L (J l j✓ "`�/l 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com