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SAN'JOAQUIN Environmental Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Dater A -L� Inspector:(&.9 §� J CONSTRUCTION Facility Address:- p s 1�_.,.i j-:\:� Well Address: r-,'S'��`� a� ��`' �— Total Depth: WP# �,UQ wy!l�`��P Well#: ^'�^5 Drilling Rig Type: Soil Boring#: Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ❑No Driller Onsite: Screen Length From: To: 4 � Fitter Pack From: To: Consultant: Geologist: �n��'v Bentonite From: To: Grout From: To: Public Water System Onsite: ]'Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes XNo casing If yes, location and distance: IFflT height SAMPLING AWVE-GppCJNp Holding Temperature: cowLfirioN OMPLETiiON Method: Ground Surface.— Screening Method: grout Verified Chain of Custody: ❑ Yes ❑Nod' ft. ft. SPOILS , = o Contamination Noted: ❑ Yes ❑No a If yes, spoils storage Location: slonad _ sac5on <= = S Covered: ❑ Yes ❑No „� If yes, material: :* GROUTING or DESTRUCTION Total Depth: (fA � =_ Depth to Water: 1� I Grout Material: C_ SZ: i MATERIALS/DEVELOPMENT Gallons of Grout Used: ""S1 Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation C Boring Destruction Slot Size: // 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 Cement 941b allons Bas PaI1111 ons Bags Thickest Thinnest pBags 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 z 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 3 35 70 7 20 0 T 40 80 8 10/16/2017 1868 E. Hazelton AvenueeII Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com