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z amu`"CSAN JOAQUIN Environmental Health Department COUNTY INS, ✓ Greatness grows hei. Monitoring Well/Soil Boring Inspection Report Date: U 2 Inspector Cj0,\_k03 5 CONSTRUCTION Facility Ay A d G �a, . C Well Address: 1 Total Depth: �g1 WP# om\ } Well#: Drilling Rig Type: Soil Boring#: " Min 2" Annular EHD Seal Verified: ❑ Yes F-1 No Drilling Company: n© Driller Onsite: Screen Length From: To: Consultant: m trj(1 7r Filter Pack From: To: Geologist: tkk%"f1 . 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: I T height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION C-IWP=CCN Method: Ground 5urfac' Screening Method: arm Verif ed Chain of Custody: ❑ Yes ❑No h' tt. tt. SPOILS = = a Contamination Noted: ❑ Yes ❑No — If yes, spoils storage Location: stott� on Covered: ❑ Yes El No ack If yes, material: zx GROUTING or DESTRUCTION Total Depth:_ __ Deptn to Water: r5 ln _ n Grout Material: k4tu�- MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring InstallationKBoring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity bTremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb allons Bags qallons Bags Thickest Thinnest 4Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 l0 Bentonite per 47 Ib 1.41 2.47 5 em 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 2U 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com