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" SAN JOAQUIN Environmen', Health Department COUNTY Monitoring Well/Soil Boring Inspection Report Date: 5 � ! Inspector: CONSTRUCTION Facility Address: /zoo i-tt!gV-"r Well Address: Total Depth: WP# DO.?gyX`/ Well#: Drilling Rig Type: Soil Boring#: 44rts" CrGw2.z Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: e,& c,, o tl✓� Driller Onsite: ';,.,,n Screen Length From: To: 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: height SAMPLING AWVE-GROUND _ Holding Temperature: COWLETION CCWPLE iON Method: G=r)d Surface "+ Screening Method: arm Verified Chain of Custody: ❑ Yes ❑No �_ft. ft. ft. SPOILS = — - o Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: sbtt� sacdon Covered: ❑ Yes El No 7avw pack If yes, material: GROUTING or DESTRUCTION Total Depth: = Depth to Water: '-t ft. —' F ft. Grout Material: h ask MATERIALS/DEVELOPMENT Gallons of Grout Used: SSn Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet e: El Boring Installation C+4Boring Destruction Bags Slot Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity L9Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94lb gall s Bags pallons Bags Thickest Thinnest ttBags Thickest Thinnest >rBags 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 s 5 25 50 5 l 105 15 30 6 30 60 6 17.5 35 cz 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sicehd.com