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_ c; SAN JOAQUIN � Environmental Health Department COUNTY— ��4iP`J Greatness grows her, Monitoring Well/Soil Boring Inspection Report Date: I Ins ec�tt r: (AA + C" CONSTRUCTION Facility Address: 2,(Y')C Well Address: Total Depth: WP# 0 bq Well#: Drilling Rig Type: Soil Boring#: �)\L . Min 2"Annular EHD Seal Verified: ❑ Yes []No Drilling Company: 1/0e_!5f- Driller Onsite: Screen Length From: To: Consultant: (-I CGS Filter Pack From: To: Geologist: s!'a6 iz!e�?- Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes Ll No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: T height T,I— —aw, SAMPLING J18CVE-GRC+UND Holding Temperature: COWLMON Cort tTCN Method: Ground S"rl'ce Screening Method: gr«n Verified Chain of Custody: ❑ Yes ❑No �tt• tt. tt. SPOILS _ Contamination Noted: ❑ Yes ❑No = If yes, spoils storage Location: sand Covered: ❑ Yes ❑No If yes, material: =_ 1:. GROUTING or DESTRUCTION Total Depth: Depth to Water: tt -ft. Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: /u Z Casing Type: ❑Well Installation ❑Well Destruction �`? Blank Feet Screen Feet Slot Size: ❑Boring Installation NBoring Destruction gags iz Cement: METHOD USED Bags Sand/Gravel: El Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: fKGravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas 9allons Bags Thickest Thinnest *Bags Thidest Thinnest VBags Bentonite/Gement Mix 3% Mix 5% Mix 2.5 5 1 l 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 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