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SKJOAQUIN Environmental Health Department —COUNTY- - Greatness grows here Monitoring Well/Soil Boring Inspection Report 4w Date: y�aY-7Uzd Inspector: 4w"IID CONSTRUCTION Facility Address: Well Address: Total Depth: WP#A047''47' Well#: Drilling Rig Type: Soil Boring#: 6-I3//,/Z, „ Drilling Company: Min 2 Annular EHD Seal Verified: El Yes []No Driller Onsite: /"`L Screen Length From: To: Consultant: Filter Pack From: To: Geologist: ��"�-' Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height iii SAMPLING 3 ABOVE-GROUND Holding Temperature: COWLETION COMPLEnoN Method: G=nd Surf=* Screening Method: �_ ism grow Verified Chain of Custody: ❑ Yes El No G t� 13 ft. SPOILS Contamination Noted: ❑ Yes El No O ;` __ _s c; 6A If yes,spoils storage Location: abed = ,� pe sacBon x: — B 1 S 3 $'- Covered: ❑ Yes El No If yes, material: GROUTING or DESTRUCTION Total Depth: /O Depth to Water: r3/ n• n' a Grout Material: '3?f " MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation E Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: L7 Gravity 2 Tremie ❑Other: Type of Method: 63-z3 Cem 71b Water Cement 941b kL-rglons Bagallons Bags Thickest Thinnest ttBags Thickest Thinnest At 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 �ir d 1 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com