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SAN JOAQUIN Environmental Health Departmen —COUNTY— ) Monitoring Well/Soil Boring Inspection Report ,3o Date: 2 Insp tor: vjovv, CONSTRUCTION Facility Address: Well Addire Total Depth: WP# uvT 6 o Welltt: Drilling Rig Type: Soil Boring#t: � V I 'lin 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: C Q Geologist: A4 t Bentonite From: To: Grout From: To: Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box O Domestic Well Onsite: ❑ Yes ❑No casing SI-}-tet If yes, location and distance: 17 height SAMPLING AWVE-GROUND Holding Temperature: °OWLET'ON COMPLETION ethod: °`°""°5"1"' Screening Method: grout s�0 Verified Chain of Custody: ❑ Yes El No �ft. CC�, tt. SPOILS =_ Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: stone a�e5on — B Covered: ❑ Yes []No If yes, material: GROUTING or DESTRUCTION Total Depth: 4,3'A' Depth to Water: C ft n' Grout Material: Gallons of Grout Used: , MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction � Blank Feet Screen Feet Slot Size: ❑Boring Installation Okoring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 47 lb Water Cement 94 lb gallons Bas gallons Ba s Thickest Thinnest uBags Thickest Thinnest SBags Bentonite/Cement Mix 3%Mix 5%Mix 2.5 5 1 5 10 1 Bentonfte 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 50 5 15 30 6 30 1 60 6 17.5 35 7 35 1 70 7 20 40 s 40 1 80 s 10/16/2017 .�0 ,1 +, Zn s 1868 E. elton Avenue I h0con, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com