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SAN,J0A0UIN Environmer ' Health Department ' —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 1 k Inspector:aayncs, CONSTRUCTION Facility Address: \S C,v!C� Well Address: L, Total Depth: WP# Well#: _ Drilling Rig Type: Soil Boring#: o) A Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: C Screen Length From: To: Driller Onsite: :!�� _ Consultant: Filter Pack From: To: Geologist: 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: ''r 2�� height SAMPLING M� ASOVE-GROUND Holding Temperature: COMPLETION �p�iEnooNCOMPLETION Method: Gi=ndSudace ' + Screening Method: Verified Chain of Custody: ❑ Yes ❑No _ft. ft. SPOILS — Contamination Noted: ❑ Yes VfNo ` _ If yes, spoils storage Location: slonad sac^on _ Covered: Vf Yes ❑No :w If yes, material: GROUTING or DESTRUCTION Total Depth:� IF IF Depth to Water: �, -' — Grout Material: No sx� LSCAP! MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation Well Destruction Blank Feet Screen Feet ❑Boring Installation ❑Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: El Pressure Grout Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons 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 lb 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 15 30 6 30 60 6 17.5 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com