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. SAN JOAQUIN Environmental Health Department J COUNTY \1trroax� Greotness grows here. �J Monitoring Well/Soil Boring Inspection Report Date: OIInspector: n;, A CONSTRUCTION Facility Address: � `- Well A dress: 0 Total Depth: WP# O _Lf-0 9 q 6 Well#: Drilling Rig Type: Soil Boring#: t� e* -) 0-41 Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: J Screen Length From: To: Consultant: A ;1/7 0 Filter Pack From: To: Geologist: t"wrl/i _ _ Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes Ll No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes [I No —�-- casing If yes, location and distance: ♦ height SAMPLING nsove-Gaourro Holding Temperature: COWLErtON COOMPtE.TION Method: Qvind Surf"' Screening Method: n grout Verified Chain of Custody: ❑ Yes Ll No �---n' tt. tt. SPOILS = Contamination Noted: ❑ Yes El No If yes, spoils storage Location: s1onad sac:on — 3 Covered: Ll Yes El No I ZO a'r.+pack If yes, material: GROUTING or DESTRUCTION Total Depth: Z� -0 _ Depth to Water: ' n — ft. Grout Material: Gallons of Grout Used: 6 q MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation7�13oring 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 471b Water Cemen 941b gallons Bas gall ons Bags Thickest Thinnest It Bags Thickest Thinnest IBags 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 1 4 1 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 8 40 1 80 8 '39 al 5 h a 10/16/2017 1868 E Hazelton Avenue Stockton. California 95205 1 T 205468-3420 1 F 209 464-0138 www.sicehd com