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`-Ou`°= SAN.AAQUIN —COUNTY— Environmental Health Department Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: �'' LI1rYty Inspector: p� 4Vc l(' . ,;L CONSTRUCTION Facility Address: Well Address: ''V_I �;S '� " � 1� , te n G Total Depth: WP# t-) t, 4 Well#: Drilling Rig Type: Soil Boring#: I Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: �� do ,�� r Driller Onsite: Z ,1� Screen Length From: To: Consultant: Filter Pack From: To: Geologist: '' 4of\ 6 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: height SAMPLING ABOVE-GROUND _N Holding Temperature: CChFLErION COt41PtEilo Method: G=nd 5ufac* Screening Method: gran Verified Chain of Custody: ❑ Yes ❑No �ft. it. tt. SPOILS — Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: stoned r — � i1C'�On a Covered: ❑ Yes El No _ vol Pack If yes, material: GROUTING or DESTRUCTION Total Depth: .4. — Depth to Water: Grout Material: L1 ll;�,,�.,k Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Size: ❑Boring Installation PBoring Destruction Bags Slot Siziz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie [�Other: E@ I Type of Method: Water Cement 47lb Water Cement 941b allons Bas gallons Bags Thickest Thinnest 9Bags 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 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