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SAN,,JOAQUIN Environmental Health Department COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date:'L`3, '1,�ector: CONSTRUCTION Facility Address: 0 G6 r'-,&%//p 4a,1 Well Address: N S b V-o C- Total Depth: WP# Well#: � n Drilling Rig Type: Soil Boring#: LP? , ? 1 3 Min 2"Annular EHD Seal Verified: ❑ Yes []No Drilling Company: C f�,S 6� Screen Length From: To: Driller Onsite: Consultant: E�J�� Filter Pack From: To: Geologist: L�Ae-C__RS Bentonite From: To: Grout From: To: Public Water System Onsite: Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes oNo casing If yes, location and distance: IH—T height SAMPLING AWVE-GROUND C.ONPLEVON C-HRMTY-BOX Holding Temperature: 00WILEnON Method: cira and Suiacs Screening Method: Verified Chain of Custody: ❑ Yes ❑Noft. ft. n. SPOILS < Contamination Noted: ❑ Yes ❑No r If yes, spoils storage Location: :bttod _ - iKJOn F: Covered: ❑ Yes ❑No If yes, material: _ .. GROUTING or DESTRUCTION Total Depth: IF Depth to Water: � -cL Grout Material: iv r Gallons of Grout Used: 5 c MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation []Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation�Boring DestructionBags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity ffTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thin n st #,441 Thickest Thinnest ttBags Bentonite/Cement Mix 3% MIX 3% MIX 2.s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 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 2D 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 www.sicehd.com