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SANcJOAQUIN Environmental Health Department COUNTY— • 9 Greatness rows here. Monitoring Well/Soil Boring Inspection Report Date: �/u Inspector:`55 CONSTRUCTION Facility Address; /O7i S i-S'on-Way Well Address: Total Depth: WP## llt.19tf Wellt --_3 Drilling Rig Type: Soil Boring Drilling Company: 91 per/ - ��,�• Min 2 Annular EHD Seal Verified: ❑Yes ❑No Driller Onsite: � Screen Length From: To: Filter Pack From: To: Consultant: l Geologist: 0 r1 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: SAMPLING jROUNo . COMPLETIQN STY-BOX • Holding Temperature: COMPLEn.oN Method: GroUnd Surf-ica Screening Method: gfout Verified Chain of Custody: ❑Yes El No —ft. ft. ft. SPOILS Contamination Noted: ❑Yes ❑No If yes,spoils storage Location: ,bn„d zF w1on t ,= Covered: ❑Yes El No If yes, material: GROUTING-or-DESTRUCTION Total Depth'. - Depth to Water: Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation XWell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity )4Tremie U;Other: Slv Type of Method: Water Cement 471b Water Cement 941b gall Bags gallons Bags Thickest Thinnest 9Bags Thickest Thinnest 9Bags BentoniteXement MIX 3% MIX 5% Mix 2.5 5 1 s 10 1 Bentonite per 47 lb 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7,5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 � C 1 30 30 0 7 17. 7 7 5 35 7 35 0 7 20 40 8 40 80 0 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138.1 www.sicehd.com