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SA ,,JOAQUIN Environmental Hea th Departni-ent —.C.O U N T Y= Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Q\ 1 W Insctor; %W� � CONSTRUCTION Facility Address: M1 -peS g" RUV Well Address: 441' Lk. �A, biiyi- Total Depth: WP# ' 1ou"A Wellt Drilling Rig Type: Soil Boring#: 3 Min 2"Annular EHD Seal Verified: 11 Yes ❑No Drilling Company: +.- Screen Length From: To: Driller Onsite: u Filter Pack From: To: Consultant: N1% Bentonite From: To: Geologist: Knii- Grout From: To: Public Water System Onsite: ❑ Yes �No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: kYes ❑No casing If yes, location and distance: 1 bn` - -7-'C& height —Q w– SAMPLING ASovr-GROUND�n CHRLSr- Holding Temperature: COt,�r'LETlON COOMPLE iON Method: GcWnd Sinal" A Screening Method: grow Verified Chain of Custody: ❑ Yes ❑Nott. tt. ft. SPOILS a Contamination Noted: ❑ Yes ❑No == If yes,spoils storage Location: - ssc^Jon _ �+ Covered: ❑ Yes ❑NoPack If yes, material: :. GROUTING or DESTRUCTION Total De9th: Al . Depth to Water: %tkoyl) \bo Grout Material: 1,)SrtM K&&N )L Gallons of Grout Used: -7 S ^ \00MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: El Boring Installation NO ring 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 I Cement 471b Water Cement 94 lb Ilons Bas allons Bags Thickest Thinnest #Bags Thickest Thinnest riBags Bentonite/Gement Mix 3%Mix 5%Mix 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 1 3 15 30 3 10 2 4 20 40 4 ` 12.5 25 5 25 50 5 15 30 6 30 I 60 6 17.5 35 7 3s 70 7 20 40 8 40 80 B 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com