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S A N J O A Q U I N Environmental Health Department U` COUNTY— Greatness grows here. �/ MonitoringWell/Soil Boring Inspection Report Date: 2� 202-`-'1 Inspector: 3gyN\ Ui_ CONSTRUCTION FacilityAddress: 2 6 106 S Pckt�'U� IZC�_ Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Screen Length From: To: Driller Onsite: Consultant: �i�j('Z,i,y�. Filter Pack From: To: Bentonite From: To: Geologist: �j. , 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 ABOVE-GROUND Holding Temperature: COf"��ION cownxnorxi Method: G=nd Surf=* Screening Method: pran Verified Chain of Custody: ❑ Yes ❑No it. ft. SPOILS = Contamination Noted: ❑ Yes El No If yes, spoils storage Location: atoll sacdon Covered: ❑ Yes ❑No If yes, material: ._ .. GROUTING or DESTRUCTION Total Depth: 2Q • Depth to Water: ' n• w — n' Grout Material: U Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet []Boring Installation Boring Destruction Slot Size: 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: i Water Cement 471b Water Cement 941b allons Bas Igall ons Bags Thickest Thinnest NBags Thickest Thinnest VBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 %.47 5 10 2 10 20 2 Bentonite er 94 Ib 2.82 .7 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 1 25 50 5 15 30 6 1 30 1 60 6 17.5 35 7 1 35 1 70 7 20 40 1 40 1 80 8 2 bW �a vkj W 1111V 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