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o156N'. SAN. JOAQUIN Environme II Health Department —COUNTY— • ..=c Greotness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: d. 6dj3= CONSTRUCTION Facility ddr ss: ZL_ K-n Well Address: Total Depth: WP# -7-7 W I#: Drilling Rig Type: Soil Boring#: "Skt p_- / + 2 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: cowLE-rlON CCOOMPLEMN Method: G=M Surfxs Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No ft. ft. ft. SPOILS Contamination Noted: ❑ Yes EP(o _= If yes, spoils storage Location: slotted sac5on = � Covered: ❑ Yes ❑No 9-101 Pack If yes, material: GROUTING or DESTRUCTION Total Depth: . _ Depth to Water: Z — tt- Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation EKoring 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 allons Bas gallons Bags Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 5 1 5 10 1 Bentonite 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 is 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1, www.sicehd.com