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SAN:=:JOAQUIN EnvironmerAll Health Department ` n: COUNTY— ' - ; Greotness grows here. - ` Monitoring Well/Soil Boring Inspection Report Date: ` \�Z\qk5Lb Inspector:a CONSTRUCTION Facility Address: �bO� t1ib`��0 V Total Depth: Well Address: �)W Drilling Rig Type: WP# �np ��_Well#: bwl'] Soil Boring#: V,' Min 2" Annular EHD Seal Verified: El Yes ❑No Drilling Company: ' " r ' � Screen Length From: To: Driller Onsite: Filter Pack From: To: Consultant: PtCL s^�� "� k�zA AgN Bentonite From: To: Geologist: 'ScL\ki.� Grout From: To: Public Water System Onsite: `qf Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes d�40 casing height If yes, location and distance: —WWT ABOVEGROUND cHRMTKBOX - SAMPLING OOMPLE1TON COMPLETION Holding Temperature: emund surrx+ =-r-=---- Method: orcut Screening Method: Verified Chain of Custody: ❑ Yes ❑No tt• SPOILS a Contamination Noted: ❑ Yes ❑No . _ If yes, spoils storage Location: .bttaa — sac�jon Covered: ❑ Yes ❑No pacy = ' if yes, material: GROUTING or DESTRUCTION Total Depth:�_ Depth to Water: x 60 M Grout Material: -t,3Sg tC l MATERIALS/DEVELOPMENT Gallons of Grout Used: LAD — Casing Type: Screen Feet ❑Well Installation ell Destruction Blank Feet Slot Size: ❑Boring Installation []Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: 4 v ressure Grout ❑Over Drill Filter Pack Type/Size: P Type of Method: ❑ Gravity Wremie ❑Other: Water cement 471b Water cement941b aliens Be s - aliens Ba seas _ BentonitelCement Mix 3% Mix 5% Mix Thickest Thinnest 9Bags Thickest Thinnest 9 _ Bentonite per 47 Ib 1.41 2.47 z5 5 20 2 Bentonite er 94 Ib 2.82 4.7 5 2 to _ p 7.5 15 3 1s 30 3 i 10 20 4 20 40 4 12.5 26 5 25 50 5 30 3o 60 6 15 6 17.5 35 7 35 70 7 20 1 4U BIt 40 e0 B 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com