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Nf SAN JOAQUIN COUNTY Environmental Health Department P/ Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: g Inspector: /O�- 14 _ CONSTRUCTION Facility Address: CL Well Address: Total Depth: WP# 00 :L Well#: ype: Drilling Rig TJ d7 Soil Boring#: Drilling Company: —� � Min 2" Annular EHD Seal Verified: ❑ Yes El No Driller Onsite: L)& Screen Length From: To: Consultant: Cy-0.W r sszc�Q Filter Pack From: To: Geologist: .efin Bentonite From: To: 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: IF7LT height SAMPLING ABOVE-GROUND Holding Temperature: COWLETION �t.EnoN Method: Ground Surfan Screening Method: Grout Verified Chain of Custody: ❑ Yes El No it. ft. SPOILS =_ Contamination Noted: ❑ Yes ❑No >" If yes,spoils storage Location: slotted sacJon x — Covered: ❑ Yes ❑No If yes, material: L = GROUTING or DESTRUCTION Total Depth: 0 Depth to Water: Grout Material: ea Gallons of Grout Used: p.� MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation 15ZBoring Destruction 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 Ceme 471b Water Cement 94 lb allons Bag Rall ons Bags Thickest Thinnest uBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 1 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 1 80 8 b�S 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sicehd.com