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SANJOAQUIN Y -_N Environmental Health Department a � —COUNTY--- Greatness COUNTY--Greatness grows here <3131 7 Monitoring Well/Soil Boring Inspection Report Date: U 7I 202'0Inspector: -t _ CONSTRUCTION Facility Address: i 5�u t Grx n2:1 1 RCA V(kCL' Well Address: Tdtal Depth: WP# Well#: Drilling Rig Type: Soil Boring#: 5 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: ' A Yom. Driller Onsite: Screen Length From: To: Consultant:�K 'A661 c (,�:� Filter Pack From: To: Geologist: C� of� o 1nk� 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: T height SAMPLING ABOVE-GROUND Holding Temperature: COWLETlON CCOMPLEnON Method: Groird S"h"y Screening Method: grout Verified Chain of Custody: ❑ Yes El No �ft. —ft. SPOILS = Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: slotted on Covered: ❑ Yes ❑No = aM* If yes, material: GROUTING or DESTRUCTION Total Depth: — Depth to Water:—,-..' Al �2 �/ ' / ��- n• n' Grout Material: Wo-I- kw�.Cl� Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity t*Tremie ❑Other: Type of Method: Water ,cement 47 lb water Cement 94 lb gallons Bas gallons Bags Thickest Thinnest 88ags Thickest Thinnest a8ags 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 1 3 15 30 3 10 4 20 40 4 12.5 25 25 50 5 15 0 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com