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SAN JOAQUIN ' Environmenar., Health Department "' � - - - -COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date:I �3 �ZI Inspector: %D� , J ' CONSTRUCTION Facility Address: 11 N /1u 4 O _fJ I Well Address: Total Depth: /� y 1 WP# #004C Well#: Drilling Rig Type: Soil Boring#: V 1 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No � Drilling Company: o Driller Onsite: Screen Length From: To: Consultant: _ e-z) Filter Pack From: To: Geologist: i e Bentonite From: To: Grout From: To: Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑Yes ❑No casing If yes,location and distance: � height —CWT SAMPLING ABOVE-GROUND COWLETION COEO Holding Temperature: COMPLETION Method: Gemmel S + Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No tt• SPOILS e Contamination Noted: ❑ Yes ❑No I = u o �,3 t36 • iS If yes,spoils storage Location: t swnad ' _ s Covered: ElYes ❑No veI� J wc#°n _ 8 S► If yes,material: GROUTING or DESTRUCTION Total Depth:, S f del s Depth to Water: tt• — n Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑,/Well Destruction Blank Feet Screen Feet ❑Boring Installation tpesoring Destruction Slot Size: / Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: d Filter Pack Type/Size: I Gravity i rem- ❑Other: Type of Method: (( w Water cement 4 lb Water Cement 941b allons Oaks gallons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags BentOnite/Ce117ent MIX 3% MIX 5%, MIX 2.5 5 1 5 10 1 Bentonite per 47lb 1.41 2.47 s 10 2 10 20 2 Bentonite per 94 lb 1 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 40 80 8 ,v2-7(� 1 4 bt�nI1S 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