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SANw OAQUIN Environmental Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: ',�IiksnN Inspector: � CONSTRUCTION Facility Address: QsaQ",Jlx\A Well Address: \�)b"l-,\ Total Depth: WP# -'� yx Aib5 Well#: V�\--3 Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: L1 Yes ❑No Drilling Company: Screen Length From: To: Driller Onsite: Consultant: V) Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes VINO COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes I'No casing If yes, location and distance: ` height 7 SAMPLING ABOVE-GROUND Holding Temperature: COMPLEMN COMPLETION Method: Ground Scuiacs' + Screening Method: groin Verified Chain of Custody: ❑ Yes ❑No �ft. tt. SPOILS - - o Contamination Noted: ❑ Yes � o If yes, spoils storage Location: slatted X*CJon -8 Covered: ❑ Yes 0, 10 — g-wipack If yes, material: r?. GROUTING or DESTRUCTION Total Depth:_ Depth to Water: Grout Material: X-1- k '- Gallons of Grout Used: �,o MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation X ,,;��ccZgags of Cement: METHOD USED Ko M� w� Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill per' "�� `��'�' Filter Pack Type/Size: ❑ Gravity ZTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gallons Bas gallill ons Bags Thickest Thinnest kBags Thickest Thinnest #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 2D 40 8 40 80 B 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com