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SAN -JOAQUIN ". ' —COUNTY Environmental Health Department Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Q ZI Inspector: Se�s CONSTRUCTION Facility Address: Z SO Tw�/-� Well Address: Total Depth: WP#j2V T A Well#: — Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: V Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING AsoVE-GROUND Holding Temperature: 00WLECION compLllirrioN Method: Ground Surface -� Screening Method: grcut Verified Chain of Custody: ❑ Yes ❑No —ft. tt. ft. SPOILS I — Contamination Noted: ❑ Yes ❑No -= _ o If yes,spoils storage Location: stoned y — sacdon _ Covered: Xes ❑No If yes, material: A _ GROUTING or DESTRUCTION Total De the i60 ��- Depth to Water: y 1l e(/�"'GO � n- " — h- Grout Material: ewe C �-^�- Gallons of Grout Used: -� /�Z�,,�(/,� MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation 'ell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installati �oring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity xemie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gall Ba allons Bags Thickest Thinnest #Bags Thickest Thinnest HBags Bentonite/Gement Mix 3% Mix 50% 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 lb 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 70 7 20 40 B 40 80 s 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.sicehd.com