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SAN JOAQUIN Environmental Health Department: —COUNTY— 'll / V 'S3 ?; (7 to Greotness gr°v+s here. b C Monitoring Well/Soil Boring Inspection Report Date: l LZA Inspector: VUUYS CONSTRUCTION Facility Address: ��4� r Total Depth: Well Address: -3 + gugti Drilling Rig Type: WP# eu#:; MMlfi� tAw* Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No Drilling Company: a Screen Length From: To: Driller Onsite: Filter Pack From: To: Consultant: C Bentonite From: To: Geologist: tf rya Grout From: To: Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑Yes ❑No casing ---�� height If yes,location and distance: T AROVE•GROUND CHRi W4M SAMPLING COMFLEMN CCMPLEnoN Holding Temperature: G wnd SW=* Method: "wt Screening Method: „. Dn X ❑Yes ❑No ft. S Verified Chain of Custody: �M SPOILS 1 Contamination Noted: ❑ Yes ❑No . = s s( slotted + C 8 If yes,spoils storage Location: -� i ` o Covered: ❑ Yes ❑Noj taw Pack If yes,material: _ 4 GROUTING or DESTRUCTION Total Dept h: y Depth to Water: Grout Material: e --�P Ili MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: Blank Feet Screen Feet ❑Well Installation Well Destruction Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure GroutQver Drill Filter Pack Type/Size: Type of Method: ElGravity K,Tremie ❑Other: Water Cement471b Water Cement941b Ba Ba s Mix allons agags BentonitelCement Mix 3%Mix S% Thickest Thinnest k a s allons ags Thickest Thinnest Bentonite per 47 1b IA I 2.47 25 s 1 5 10 1 2.82 4.7 5 30 2 10 20 2 Bentonite per 94 lb 3 15 10 15 3U 3 30 20 4 20 40 4 5 25 50 5 l t \ 1is 25 30 60 6 1 19 30 6 7 17.5 35 39 70 111 20 40 40 80 B 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