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"N SAN JOAQUIN Environmental Health Department I — COUNTY--- car F`oe;�P Greatness grows herr Monitoring Well/Soil Boring Inspection Report Date: Ins ector: �4� CONSTRUCTION .� p / Facility Address: taytL �. ��, Well Address: Total Depth: WP# 6C3'ly'97C) Well#: Drilling Rig Type: A/ke &eeOwp le,9 Soil Boring#: Vr I L% a-f Drilling Company: - ��, Min 2" Annular EHD Seal Verified: El Yes ❑No Driller Onsite: , � �, Screen Length From: To: Consultant: �a Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: T height SAMPLING ABOVE-GROUND Holding Temperature: cowLE7r10N COMPLETION Method: Ground Surfacs " + Screening Method: grout Verified Chain of Custody: ❑ Yes El No n' ft. SPOILS f ft. Contamination Noted: El Yes ❑No If yes, spoils storage Location: stand aac�cn _ Covered: ❑ Yes ❑No V&Vqq Pack If yes, material: GROUTING or DESTRUCTION Total Depth:_ _ Depth to Water: AIJ �� tt• Grout Material: Al MATERIALS/DEVELOPMENT Gallons of Grout Used: I—Axis Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation koring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gall Bags Rallons Bags Thickest Thinnest uBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1 .41 2.47 5 10 2 10 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 plat", 15 30 6 30 60 6 s�'< 17.5 40 8 40 80 1 8 tl 4 4 10/16/ 17 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com / A_