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,s SAN JOAQUIN Environmental Health Department --COUNTY— Greatness grows 5er, Monitoring Well/Soil Boring Inspection Report 1! Date: C) Ins ctor. L C CONSTRUCTION Facility Ad ress: ' Lee I/ Well Address: Total Depth: WP# L% %r Well#: Drilling Rig Type: 44'>� Soil Boring#: - - Drilling Company: ;`j f S Min 2"Annular EHD Seal Verified: 11 Yes ❑No Driller Onsite: ( � � ? c� C (� Screen Length From: To: Consultant: Filter Pack From: To: Geologist:_ ___ Va. �S S U_____ Bentonite -From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No I I casing If yes, location and distance: _ height SAMPLING ABOVEGROUND Holding Temperature: COWLEMN CO _WLEMN Method: Grocind Stars Screening Method: grout Verified Chain of Custody: ❑ Yes El No -` ft• tt. ft. SPOILS - — Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: ancien x = Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: N A ft — ft• Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: - Casing Type: []Well Installation ^�[]Well Destruction Blank Feet Screen Feet ❑Boring Installation t. Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: J Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gallons Bags allons Bags Thickest Thinnest 4Bags Thickest Thinnest =Bags Bentonite/Cement Mix 3% Mix 5%MIX 2.5 5 1 5 1 10 1 Bentonite per 47 Ib 1.41 2.47 s 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 30 3 10 20 4 20 1 40 4 12.5 25 5 25 I 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com