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SAN JOAQUIN v I=� —COUNTY Environmental Health Department I_3 cq ?.• Greotness grows here. Monitoring Well/Soil Boring Inspection Report Date: ' I n2�5 Inspector: S �'1�Ilrlh'IG1VaV1�� CONSTRUCTION SV rn Facility Address: Wlo tram tare, 1,0AL Well Address: Total Depth: WP#_Z9AML Well#: �I ,V13�V1� Drilling Rig Type: Soil Boring#: Ot, Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: hlhaocd is Driller Onsite: Screen Length From: To: Consultant: V A C-10 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 GaouNfl Holding Temperature: COMPLETION COMPLETION Method: Ground Surf"' Screening Method: crow Verified Chain of Custody: ❑ Yes ❑No -n• ft. tt. SPOILS = 0 Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: sbwnd .on Covered: ❑ Yes El No _ s-v+pwk If yes, material: I GROUTING or DESTRUCTION Total Depth: x Lf Depth to Water: — n• _ tt• Grout Material: Gallons of Grout Used: �2= ��(A �Y�_I ll 1 MATERIALS/DEVELOPMENT � Casing Type: V�Vell 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: KG ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gall Bags gallons Bags Thickest Thinnest 9Bags Thickest Thinnest Bags Bentonite/Cement Mix 3%Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 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 8 40 80 a 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com