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�AQU'Nc SAN:.JOAQVIN INS _ Environmental Health Department � COUNTY Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: (OIC Inspector: CONSTRUCTION Facility Address: fi Ah"L1 }. I$ -8.I0 Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No DrillingCompan Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe EJ Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: I T height SAMPLING ABOVE-GRouNo Holding Temperature: COWLET10N CCC#APLEnoN Method: Gmund SLwlwv Screening Method: grotA Verified Chain of Custody: ❑ Yes ❑No —n' ft. ft. SPOILS ^ Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: abed 8 aeon Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUC I N Total Depth: J. __ IF Depth to Water: k n• tt' Grout Material:Rat C P Gallons of Grout Used:_ I� MATERIALS/DEVELOPMENT p Casing Type: E]Well Installation ❑Well Des ruDion Blank Feet Screen Feet ❑Boring Installation Poring Destruction Slot Size: bot CY00k_ env Bags of Cement: METHOD USED V w� Bags Sand/Gravel: 'Okes❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity KTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas eallons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 s 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 �,etJ111J V l� 15 30 6 30 60 6 17.5 ZJi` (A 1 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