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<2. PGUW,•zi SAN.tJOAQUIN t; Environmental Health Department Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 20 Inspector: ' aUa^ tt CONSTRUCTION Facility A dress: 15— Well Address: T Total Depth: WP# Well#: Drilling Rig Type: SHS-t Soil Boring#: A/— 92 Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Driller Onsite: OP Screen Length From: To: Consultant: Filter Pack From: To: e6o /ljy�i Bentonite From: To: Geologist: 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 AWVE-GROUND Holding Temperature: COMPLETION COMPLETION Method: Grand Surfaos' + Screening Method: orotA Verified Chain of Custody: ❑ Yes El No —tt. n. tt. SPOILS : >v Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: slotted sac�on _ Covered: ❑ Yes ❑No = 9,,,61 Pack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: f"12—/f/ Grout Material: Oat" e W"u'7 MATERIALS/DEVELOPMENT Gallows of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ElN (Gravity Tremie ❑Other: Type of Method: Water ("emerf-47110("em—47110Water Cement 941b allons Bas gallons Bags Thickest Thinnest 1t Bags Thickest Thinnest SBags 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 BentonRe per 941 2.82 4.7 7.5 15 3 15 30 3 10 204 20 40 4 12.5 25 5 25 50 5 15 6 30 60 6 17.5 35 0 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 209 464-0138 1 www.sicehd.com