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SAN��OAQUIN `O `Z Environmental Health Department CaUNTY— c"c�oa�`r Greatness grows here. Monitoring Well/Soil Boring InspeC•tion Report Date: l Inspector: CONSTRUCTION Facility Address: Well Address:g 21 (O�al�t 4N�'i �� V(t-"Total Depth: n C� WP# 113Q0o R0. Well#: Drilling Rig Type: A VQ 1' p Soil Boring#: Drilling Company: W� L A Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Driller Onsite: `� ,L ('�y—.^gyp Screen Length From: To: Consultant: Filter Pack From: >U To:'2\b Geologist: _ Bentoni,.te From: To: Grout From: To: Public Water System Onsite: ❑ YTs---'ElNo COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: MYes ❑No casing If yes, location and distance: height SAMPLING AWVE-GRC)UND OX Holding Temperature: 'CO �zfON C�^�nwUMON Method: G-ound Sudacs Screening Method: grout I Verified Chain of Custody: ❑ Yes ❑No S tt. ft. SPOILS t _ = a Contamination Noted: ❑ Yes El No 1= If yes,spoils storage Location: I = c A sr n — Covered: ❑ Yes ❑No y — 9-1 Pack If yes, material: GRO017IMor DESTRUCTION Total Depth:��?LFE Depth to Water: Grout Material: 'go)A" 10 Shy_Gallons of Grout Used: MAMATERIALS/DEVELOPMENTll � �y� Casing Type: ]Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation ❑Boring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: _ Filter Pack Type/Sizej�t K J ❑ Gravity l Tremie ❑Other: Type of Method: �ik-i vits` Water Cement 47lb Water Cement 94lb gall Bags gallons Bags Thickest Thinnest 4Bags Thickest Thinnest VBags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 5 1 s 1 10 1 Bentonite per 47 lb 1.41 2.47 5 10 2 10 1 20 2 Bentonite per 94 lb 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 I 60 1 6 17.5 35 i I 35 70 7 20 40 8 1 40 I 80 I 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