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SAN JOAQUIN <br />COUNTY - <br /> Environmer Health Department <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: L- (Z CONSTRUCTION <br />Facility Address: (0,kri <br />Well Address: Total Depth: <br />WP# Well#: V6v1 /41-'7--)ft5 -5β€” Drilling Rig Type: <br />Soil Boring#: - <br />β€˜ Drilling Company: /4 Min 2" Annular EHD Seal Verified: El Yes Ill No ' A) <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />To: <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout From: <br />To: <br />To: <br />To: <br />Public Water System Onsite: 0 Yes 0 No <br />Domestic Well Onsite: 0 Yes ON° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />COMPLETION El Stove Pipe 0Christie Box <br />casing <br />height <br />CHAMTY-440X <br />COMPLETION <br />Verified Chain of Custody: 0 Yes IllNo <br />SPOILS <br />Contamination Noted: 0 Yes 0No <br />If yes, spoils storage Location: <br />Covered: 0 Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: IP 426.) 22, 145) 104 <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: 30aj) j SI-2 i <br />0Well Installation IRWell Destruction Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Screen Feet <br />El Boring Installation Boring Destruction <br />METHOD USED <br />0Pressure Grout 1:9β€˜er Drill <br />12-ravity Etfremie 0Other: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest # Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.corn