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SWJOAQUIN Environmental Health Department --COUNTY— . Gnrnluess gra vis here. Monitoring Well/Soil Boring Inspection Report Date: q Zy Inspector: CONSTRUCTION Facility Address: kUt I.Q. , Well Address: Total Depth: WP# :2%4 00213 W�elll#: Drilling Rig Type: Soil Boring#: SU 1 5 s 6- I� Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: 6r�CoV11P Driller Onsite: Screen Length From: To: Consultant: aY� r�Qf s^ In,eer)na �'Sc; Filter Pack From: To: Geologist: SPran a T Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: El Yes ❑No casing If yes, location and distance: � height; SAMPLING ABOVEGROUND COWLErwN CHRI5IY-eOx Holding Temperature: COMPLE'noN Method: Grow d s nlac. "�— Screening Method: 61 ZZ, RIM, haul Verified Chain of Custody: ❑ Yes ONO t —tt SPOILS �f Contamination Noted: ❑ Yes ❑No 6to -sd If yes, spoils storage Location: alcnea = s action Covered: ❑ Yes ❑Now 5Jt = y„vd pad If yes, material: 2ALy� , 8 =_ GROUTING or DESTRUCTION Total Depth: Depth to Water: W Grout Material: Nat I C—A Ivy—K� MATERIALS/DEVELOPMENT Gallons of Grout Used: 2+ qw� 2�a [L l- Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation Woring Destruction Slot Size; Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity XTremie ❑Other: Type of Method: Water ment471b Water Cement941b allons B375 gallons Bags Thickest Thinnest av Thickest Thinnest psalls Bentonite/Cement Mix 3% MIX 5% MIX 2.5 5 1 5 10 1 Bentonite er47lb 1.41 2.47 s 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 7.5 15 3 15 30 3 _ 10 20 4 20 40 4 12.5 25 5 25 50 5 35 30 6 30 60 6 17.5 35 7 35 70 7 20 40 0 40 00 0 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com