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SM.4JOAQUIN Environmental Health Department —.C.O U N T Y=— Greatness grows here- Monitoring Well/Soil Boring Inspection Report Date: 5�2C Inspector: 7/ ^AttsL �� CONSTRUCTION Facility Address: (PC 4i w E. !( a,I .�_ Well Address: T tal Depth: _ // 4 WP# uc ' �E 6?i Well#: ng Rig Type: l I Soil Boring#: 1 S(o�C�fi Drilling Company: \` in 2"Annular EHD Seal Verified: El Yes ❑No �.; Driller Onsite: N i C k Screen Length From: To: Consultant: A dr,ev) Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: A might _ SAMPLING _ ABOVE-GRcMn - Holding Temperature: ComPL TlQfii F rio Method: Ground Sala= Screening Method: Verified Chain of Custody: ❑ Yes ❑Nc, SPOILS Y Contamination Noted: ❑ Yes ❑No T= = If yes,spoils storage Location: a[attsd - ascaon _ -� Covered: El Yes ❑No -F If yes, material: ._ GROUTING or DESTRUCTION Total Depth: Depth to Water: Grout Material: �. rd (.r b-t 0 Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation []Well Destruction Blank Feet Screen Feet ❑ Slot Size: iz Boring Installation NBoring Destruction Bags Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity [pTremie ❑Other: Type of Method: Water cement 471b Water Cement 94 lb I Bags I Bags Thickest Thinnest Bags Thickest Thinnest ti Bags Bentonite/Cement Mix 3% MIX % Mix 2,5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 5 to 2 10 20 2 Bentonite per 94 Ib 2.821 4.7 7.5 15 3 15 30 3 SO 20 4 20 1 40 4 12,5 1 25 5 25 1 5o 5 15 30 6 30 60 6 17.5 35 I 7 35 70 7 20 40 8 40 80 8 � �1� N'o'? 10/16/2017 'h� 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 wwv✓.sicehd.com