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SAN.JOAQUIN Environmental Health Department —COUNTY— Grerjtnes5 grows here. Monitoring Nell/Soil Boring Inspection Report Date: ' 2�1`` Inspector: CONSTRUCTION Facility Address: Well Address: Total Depth: WP#QQ4 Q Well#: Drilling Rig Type: Soil Boring#: \-S Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist:��N& Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes �No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes INlo casing - If yes, location and distance: height T SAMPLING ABOVE-GROUND Holding Temperature: COkPLETION C-awLE iON Method: G=ndStaiacs. + Screening Method: o� Verified Chain of Custody: ❑ Yes ❑No % tt. SPOILS — Contamination Noted: ❑ Yes ❑No r If yes,spoils storage Location: a slotted sacJon x: Covered: ❑ Yes ❑No Pack If yes, material: R._ GROUTING or DESTRUCTION Total Depth: • Depth to Water: tL ' — n• Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: El Boring Installation VkBoring 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 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 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 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 r77;7 80 8 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