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C"�U'"� SAN JOAQUIN --COUNTY Environmental Health Department ' 1 / - — �q�,F�PGreatness grows here. C C Monitoring Well/Soil Boring Inspection Report Date: J J Inspector- i 0- 14 , CONSTRUCTION Facility Address: 'eW Ve_ Well Address: Total Depth: WP# 60 Well#: Drilling Rig Type: ('S Soil Boring#:1— Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Screen Length From: To: Driller Onsite: Clad Consultant: Filter Pack From: To: Geologist: ✓' C_ Bentonite From: To: 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: COWLErtON COMPLEMN Method: Ground Surface Screening Method: arm Verified Chain of Custody: ❑ Yes ❑No —n' tt. ft. SPOILS � = a Contamination Noted: ❑ Yes El No " If yes, spoils storage Location: abxad _ - s.c�on Covered: ❑ Yes ❑No g,f pack If yes, material: GROUTING or DESTRUCTION Total Depth: 3• Depth to Water: " 4 fL ft' Grout Material: ^-�'7j� MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation'�$oring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity �kremie ❑Other: Type of Method: Water Ceme 471b Water Cement 94 lb allons gall ons Bags Thickest Thinnest #Bags 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 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 b AAr 10/16/2017 1868 E. Hazelton Avenue I Stocckton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com