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SANTJOAQUIN Environmental Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: I 1P Inspector: CONSTRUCTION Facility Address: �,�'1 'l, %�'� Well Address: 5r. _- t', Total Depth: 3 Q0 WP# \.%,\ S o Well#: N IYa Drilling Rig Type: Npj\n,p ao7sc�� Soil Boring#: Min 2"Annular EHD Seal Verified: tk Yes [I No Drilling Company:�� Driller Onsite: Screen LengthN)lFrom: To: Consultant: via Filter Pack From: 10 0` To: Geologist: 'n,_,JJ Bentonite From: To: Grout From: To: To: Public Water System Onsite: ❑ Yes IN COMPLETION ❑ Stove Pipe []Christie Box Domestic Well Onsite: ❑ Yes l (N0 casing If yes, location and distance: height SAMPLING �1� 1WVE-GROUND Holding Temperature: COMPLE )ON CCOMPPLEnCCN Method: G=rjdSurtacs T Screening Method: Q*aA Verified Chain of Custody: ❑ Yes ❑No foo n tt. fi. SPOILS N\� Contamination Noted: ❑ Yes ❑No t: L tsc�V.op F If yes,spoils storage Location: saaion Covered: ❑ Yes ❑Nogravol— P hail M'�t If yes, material: . GROUTING or DESTRUCTION Total Depth: Depth to Water: � 5 n. Grout Material: s Gallons of Grout Used: r �k bo MATERIALS/DEVELOPMENT Casing Type: 'Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity Premie ❑Other: Type of Method: Water Cement 471b Water Cement 94lb allons Bas gallons Bags Thickest Thinnest tt Bags 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 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 35 707 20 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com