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SAN.IOAQUIN Environmental Health Department ' —COU NTY— Gree±ness grows here. MonitoringWell/Soil Boring Inspection Report Date: �/I Z�Z Z Inspect-or: SLkS3�"u`/ CONSTRUCTION Facility Address. �0� ZeVt, y� . , < Ktv Well Address: Total Depth: WP# 00 � Well#: Drilling Rig Type: Soil Boring#: L113 Drilling Company: CUI- NE V 6 Z T-ky-41 d4,, Min 2" Annular EHD Seal Verified: ❑ Yes []No Driller Onsite: Screen Length From: To: Consultant: t� C�Ir OCIG7 e _r,- �C, Filter Pack From: To: Bentonite From: To: Geologist: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes []No using If yes, location and distance: height SAMPLING Agp,,rg..GRCUNp Holding Temperature: C�OMPL TION =-wP�LE77GN Method: Ground Swiacs Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No ft. ft. tt. SPOILS = = P Contamination Noted: ❑ Yes ❑No = If yes,spoils storage Location: �3ottAd = sscaon Covered: ❑ Yes ❑No = a aCK If yes, material: w= GROUTING or DEST UCTION Total Depth:Q l S Depth to Water: `h e r CUl„�. '1�2 n• _ n Grout Material: � � C� Gallons of Grout Used: A bo(.,,tq�czL , to I-) MATERIALS/DEVELOPMENT Casing Type: []Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: []Boring Installation oring Destruction gags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: XGravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest ttBags 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 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 1 40 00 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