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SAN JOAQUIN Environmental Health Department COUNTY Greotness grows here. Monitoring Well/Soil Boring Inspection Report . Date: is I'Mu Inspector: ` CONSTRUCTION Facility Address: TrA Well Address: Total Depth: WP# 116011616 Well#: ("�� 2 Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: eL)CPt'ltlfiC Dri 11V1a� 1�r Driller Onsite: Screen Length From: To: '� Filter Pack From: To: Consultant: t ►'1l� Geologist: w.� 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: WT height SAMPLING ABOVE-GROUND C�HRLM_ Holding Temperature: COMSPLE71ON CC>MP=CN Method: C3round Surfacs + Screening Method: groat Verified Chain of Custody: ❑ Yes ONO �ft' ft. ft. SPOILS = Contamination Noted: ❑ Yes ❑No = r If yes, spoils storage Location: sacdon — .S Covered: ❑ Yes ❑No r' = sew+pa-k If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: tt n Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: ti Casing Type: Well Installation ❑Well Destruction Blank Feet Screen Feet e: ❑Boring Installation ❑Boring Destruction Bags Slot Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity [KTremie ❑Other: Type of Method: Water Coent 471b Water Cement 94lb allons Ba s gallons Bags Thickest Thinnest B. Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% 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 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 1 60 6 17.5 35 7 35 70 7 20 40 8 40 1 80 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com