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SANJOA00 1 —COUNTY— Envoronmer Health Department Greatness grows hpre. Monitoring Well/Soil Boring Inspection Report Date: F-Inspector: k CONSTRUCTION Facility ddress: G Well Address: � Total Depth: WP# tL CTO 77 Well#: Drilling Rig Type: Soil Boring#: 'J,J Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No Driller Onsite: Screen Length From: To: Consultant: 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: height SAMPLING ABOVE-GROUND A1S iY Holding Temperature: COMPLETION Method: Gmun SLwlaov CC{iHRISW-BOXQN Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No k— ft. ft. SPOILS ft. _ Contamination Noted: ❑ Yes ❑No = If yes, spoils storage Location: = s afott�d r on = Covered: ❑Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth:_�S_ - - Depth to Water: Grout Material: �' Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: []Well Installation ❑Well.Destruction Blank Feet Screen Feet ❑Boring Installation Wf orie: ng Destruction Bags Slot Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity remie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb gallons Bags Rallons Bags Thickest Thinnest 4Bags 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 s 10 2 10 20 2 7.5 15 3 15 30 3 Bentonite per 94 Ib 2.82 4.7 -i 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 1 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 ( T 209 468-3420 1 P 209 464-0138 I, www.sicehd.com