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SAN J O A S I N Environmental Health Department COUNTY— irrringi.i rf Monitoring Well/Soil Boring Inspection Report Date: l / l� Inspect :" our/,,,. CONSTRUCTION Facility Address: E r" Well Address: Total Depth: f WP# 00q99 6 Well#: Drilling Rig Type: Soil Boring#: - I U�DMin 2"Annular EHD Seal Verified: Yes ❑No Drilling Company: Geo - ' X Driller Onsite:—Tom Screen Length From: To: Consultant: A crom Filter Pack From: To: Geologist: C S Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: F-1 Yes ❑No casing If yes, location and distance: height SAMPLING ASQYH-GROUND c4iRISMY_ Holding Temperature: cowp ;ON COMPLETION Method: G=nd Surra, Screening Method: grout Verified Chain of Custody: ❑ Yes El No _L_—ft. ft. SPOILS —_ _ a Contamination Noted: ❑ Yes El No _ If yes,spoils storage Location: ■torted = Bacton Covered: ❑ Yes ❑No = > If yes, material: rr — GROUTING or DESTRUCTION Total Depth: Depth to Water: MA — ft Grout Material: &f CeAml tt- MATERIALS/DEVELOPMENT Gallons of Grout Used: 119 Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation Boring Destruction Slot Size: I� Bags of Cement: METHOD USED = Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity IATremie ❑Other: Type of Method: Water Cement 47 Ib water Cement 941b allons Bags Raill ons Bags Thickest Thinnest "Bags Thickest Thinnest "Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 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 SO 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 40 80 8 10/16/2017 1868 E. Hazelton u bI�Stockton, California 95205 1 T 209 468-3420 I F 209 464-0138 I _www.sicehd.com Pl