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SAN JOAQUIN Environmental Health Department --COU NTY- Moonni_tloring Well/Soil Boring Inspection Report Date: 16 Inspector: C9 CONSTRUCTION Facility Address: 2S 2\Z S. S V_ , Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: 01 Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: L Screen Length From: To: Consultant: V - PX P Filter Pack From: To: Geologist: tAp_ryrv. Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No If yes, location and distance: COMPI INIC. Holding Temperature: Method: Screening Method: Verified Chain of Custody: SPOILS Contamination Noted If yes, spoils storage Location: ❑ Yes ❑ No ❑ Yes ❑ No Covered: ❑ Yes ❑ No If yes, material: GROUTING or DESTRU TION Total Depth: -P-? Depth to Water: Grout Material: a rv.(Y� Gallons of Grout Used: ti c Well Installation ❑N� Well Destruction 2� ❑ ❑Boring InstallationgBoring Destruction METHOD USED j' J ❑Pressure Grout ❑Over Drill ravity ❑Trriie ❑Other: Water allons Cement 471b Bas water allons Cement 941b Bags Thickest Thinnest #Bags Thickest Thinnest #Bags 2.5 5 1 5 10 1 5 10 2 10 20 2 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 MATERIALS/DEVELOPMENT Casing Type: Blank Feet Slot Size: Bags of Cement: Bags Sand/Gravel: Type/Brand of Bentonite: Filter Pack Type/Size: Type of Method: Screen Feet Bentonite/Cement Mix 3% Mix 3% Mix Bentonite per 47 Ib 1.41 2.47 Bentonite per 94 Ib 2.82 4.7 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