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SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />Greatness grows herc <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Ma/tx Inspector: A.Aseat. <br />Facility Address: 1111 ititectod /hot. <br />Well Address: <br />W P# .6+04/3D IC Well#: <br />Soil Boring#: f, 7, <br />Drilling Company: /OA, T. <br />Driller Onsite: V A7/a/nk4. <br />Consultant: 4/Ivy( <br />Geologist: l2er <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: Li Yes LINo <br />To: <br />To: <br />To: <br />To: <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />Public Water System Onsite: CI Yes ON° COMPLETION Li Stove Pipe 111Christie Box <br /> <br />Domestic Well Onsite: DI Yes EN° <br />If yes, location and distance: <br />casing <br />height <br /> <br />SAMPLING <br />Holding Temperature: <br />Method: <br /> <br />ABOVE-GROUND <br />COMPLETION <br /> <br />CHRISTY-BOX <br />COMPLETION <br /> <br />Ground Surface <br /> <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: Li Yes El N o <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 6O t <br />Depth to Water: eo t <br />Grout Material: "VI erertZste <br />Gallons of Grout Used: c ectUdiA GL - <br />LII Well Installation El Well Destruction <br />111Boring Installation oring Destruction <br />METHOD USED <br />El Pressure Grout ElOver Drill <br />111 Gravity <br /> 2Tremie DOther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest /*Bags Thickest Thinnest flags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 e 40 80 8 <br />ft <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />_ft <br />slotted <br />secton <br />tt <br />LI Yes ON° <br />Yes ElNo <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com