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0 No Public Water System Onsite: 0 Yes <br />SAN JOAQUIN <br />COUNTY <br />Greutries grcms hete <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 9)13/22 Inspector: SCATV-(15 1 CONSTRUCTION <br />Facility Address: 35 j.h(v\&ft PA <br />• <br />7.4 5 <br />Environmental Health Department <br /> TratA1 <br />\A/P# oo -56 cl) Well#: <br />Soil Boring#: <br />Drilling Company: 1 4- roL—Lex_ 1/-\ <br />Driller Onsite: <br />Consultant: _Y--:\r-Ck---/Ct V\ <br />Geologist: <br />Domestic Well Onsite: El Yes ON° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: LI Yes 0 No <br />SPOILS <br />Contamination Noted: 0 Yes 0 No <br />If yes, spoils storage Location: <br />Covered: 0 Yes 0 No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: ( 5 I <br />Depth to Water: 31 <br />Grout Material: neat- Cieflted <br />Gallons of Grout Used: <br />111 Well Installation 111 Well Destruction <br />1=IBoring Installation M-Boring Destruction <br />METHOD USED <br />IIIPressure Grout I=10ver Drill <br />0 Gravity a(Tremie 00ther: <br />Water <br />gallons <br />ment 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest 0 Be , Thickest Thinnest 0 Bags <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 6t4./ 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />casing <br />height <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: CI Yes IIINo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION LI Stove Pipe 0 Christie Box <br />Ground Surfao• <br />grout <br />_ft. <br />slonad <br />&scion <br />1 tt. <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />ft <br />ft <br />ft. <br />From: <br />From: <br />From: <br />From: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen <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 />Well Address: <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />Feet