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SA N J OAQ U I N Environmental Health Department —COUNTY— re I (Ittiess grows here. Monitoring Well/Soil Boring Inspection Report Date: 12 k3 ZZ Inspector: �G 1taS CONSTRUCTION Facility Address: _ V-" �q3 Well Address: ,o Total Depth: WP# V 0 'AK \3 t ` V Well#: Drilling Rig Type: Soil Boring#: `)6 y5 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: rA_ Driller Onsite: rM O Screen Length From: To: Consultant: &U X prs s ,. C� .t,�� IB _ k Filter Pack From: To: C , Geologist: 5MWA . 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 WSAMPLING AWVE•GROUND cti STY-Sox COMPLETION Holding Temperature: COMPLETION Method: croUnd Sudws Screening Method: orocrt Verified Chain of Custody: ❑ Yes El No �ft. ft. SPOILS ft• = Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: stoned Covered: ElYes ❑No section9_Vw Pak* c If yes, material: r 1 ----GROUTING-or-DESTRLJCT-ION Total-Depth: 15 __ T Depth to Water: ft• `" " n• Grout Material: +- MATERIALS/DEVELOPMENT Gallons of Grout Used: 'V Casing Type: , Well Installation ❑Well Destruction JJ Blank Feet Screen Feet ylat�•❑ Slot Size: Boring Installation ❑Boring Destruction n' Bags Size: Cement: METHOD USED Bags Sand/Gravel: Type/Bran-d of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cemen 471 Water Cement 941b allons Bags Rallons Bags Thickest Thinnest #Bags" Thickest Thinnest #Bags Bentonite/C.ement Mix 3% Mix 5%Mix 2.5 5 1 9 5 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 15 30 6 30 60 6 17,5 35 7 35 70 7 20 40 8 40 80 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