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SAN JOAQUIN Environmental Health Department COUNTY Greotness gro-,vs here. Monitoring Well/Soil Boring Inspection Report Date: l r*v�� N Ins ector: -y Ck1 CONSTRUCTION Facility Address: Well Address: Z 0 0 �'� Y-. CK ,—O` ' Total Depth: WP#-00 75 VeYl Well y o3 0,9 Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes []No Drilling Company: Co(/-c- Driller Onsite: yi4Lie- Screen Length From: To: Consultant: ��Cp,�S�n., Filter Pack From: To: o i�� Geologist: fekx^1. r--; .-)I Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABovE-GROU vD CHRISTY-Holding Temperature: COMPLETION COMPLETION Method: c3=nd Surfaco " , Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No --n- ft. ft. SPOILS yam. Contamination Noted: ❑ Yes El No .vSr C If yes, spoils storage Location: siattvd �.- � sa on Covered: ❑ Yes ❑No r W If yes, material: � GROUTING or-DESTRUCTION Total Depth: 3 c3 Depth to Water: tt. Grout Material: Gallons of Grout Used: 0 p MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation AN-ell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity remie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gallon s -Bags gallons Bags Thickest Thinnest #8ags 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 1 35 7 1 35 70 7 20 40 s 40 80 a 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com