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SAN JOAQUIN Environmental Health Department —COU NTY— J_ _ J` Monitoring Well/Soil Boring Inspection Reporto z� lg � Date: Insp tor: Vv CONSTRUCTION �it�'� Facility Address: , -I'a v,�--�'C v zi Well Addr_e : Total Depth: P 2 / �� 4- WP# �J l) Well#: Drilling Rig Type: S Soil Boring#: � Drilling Company: I t/ KAin 2"Annular EHD Seal Verified: ElYes ❑No Driller Onsite: Screen Length From: To: Consultant: -. - Filter Pack From: To: Geologist: J Bentonite From: To: Grout From: To: l Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box �n Domestic Well Onsite: ❑ Yes ❑No casing If yes,location and distance: TV height SAMPLING ABOVE-GROUND Holding Temperature: °ONFLE 1ON co LS-ryox Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No —ft. SPOILS "- -a: _ Contamination Noted: ❑ Yes ❑No — If yes,spoils storage Location: ebzwe setaon = B Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: Z�r -it Ao'A I X17-Z. Depth to Water: e ft _ ft• Grout Material: Gallons of GroutUsed: fJ MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well DestructionBlank Feet Screen Feet Slot Size: ❑Boring Installation^pring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water cement 471b Water Cement 941b gallons Bags gallons Bags Thickest Thinnest NBags Thickest Thinnest 9Bags 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 1 4 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 50oel `v 2-0� � 10/16/2017 1868 E. Ha6lton Avenue II' Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com