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SAN:JOAQUIN Environmental Health Department —COUNTY— �j Monit1o�ri�ngW� ell/Soil Boring Inspection Report Date: f 5nsneqor: V V V I C^ CONSTRUCTION Facility Address: i k a;0 —1 / Well Address: Total Depth: WP# W� W II#: Drilling Rig Type: 1 i Soil Boring#: Tl � Drilling Company: j Min 2 Annular EHD Seal Verified: El Yes []No aS Driller Onsite: b.,-, Screen Length From: To: Consultant: p Filter Pack From: To: Geologist: y� Bentonite From: To: Grout From: To: Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COWLEfION CCOMPLETlON Method: G rwnd Swfact— Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �ft. tt. SPOILS _ 0 Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: abtt.d on = E Covered: ❑ Yes ❑No _ If yes, material: i .a EE _ .. GROUTING or DESTRUCTION Total Depth: 5 - = :• Depth to Water: f Ui� tt' Grout Material: A h 6Yc�y l Gallons of Grout Used: S,aX<d WTERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction nSlot Size: j('JR P Q Blank Feet Screen Feet ❑Boring Installation 10Boring Destruction 10 d\ �+_ Bags of Cement: METHOD USED 1 rO v tY�5 Bags Sand/Gravel: [nL S' Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: 51Aravity ❑Tremie ❑Other: Type of Method: water Cement 47 lb Water Cement 94 lb gallons Bags gallons Bags Thickest Thinnest BBags Thickest Thinnest >1Bags Bentonite/Cement Mix 3%Mix 5%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 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 1 30 6 30 60 6 17.5 35 7 35 70 7 20 14 8 1 40 80 8 -j0 ? 10/16/2017 1868 E.'fiazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com