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QUIN SAN4,J0A0UIN TCOUNTY— Environmental Health Department l Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: s °� Inspector: CONSTRUCTION Facility Address: Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: llP-%qV 'Q1- Min 2"Annular EHD Seal Verified: ❑ Yes ❑No � Drilling Company: JCILU, Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: ML--ks' QOOyv'�tt-* Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: A:Ijl— height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION CCOMPLETION Method: cfamdsuia" "+ Screening Method: gr f o«n Verified Chain of Custody: ❑ Yes L1 No i:. ft. SPOILS `,mss Contamination Noted: ❑ Yes ❑No — If yes,spoils storage Location: Covered: ❑ Yes ❑No =' _ :w = gray.l aaas If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: n n• Grout Material: 1A)�'( Gallons of Grout Used: �Gj �Qt��J1j MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation s Boring Destruction Bags Size: Cement: METHOD USED I� 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 Bas gallons Bags Thickest Thinnest it Bags Thickest Thinnest V Bags 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 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 a 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com