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SAN.JOAQUIN—COUNTY--- Environmental Health Department • GretlLnei.. grows iicre. Monitoring Well/Soil Boring Inspection Report Date: Inspector: CONSTRUCTION Facility Address: t�i'o T if 1Z Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: KWI Min 2"Annular EHD Seal Verified: ❑Yes El No ' Drilling Company:_ Driller Onsite: AV MO,V1 I b Screen Length From: To: Consultant: D ae V 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 _QwT 17 T SAMPLING AWVE-GROUND COMPLETION CHRISTY-SOX ' Holding Temperature: COMPt.ET1oN Method: G=ncl surface Screening Method: Grout Verified Chain of Custody: ❑Yes ❑No ft• tt. ft. SPOILS Contamination Noted: ❑Yes ❑No ` If yes,spoils storage Location: Covered: ElYes ❑Noon S '. p Iawl pack If yes,material: EE i I GROUTING or DESTRUCTION Total Depth: 1 ( 20 Depth to Water ft, a" _ ft• Grout Material: �00Ak�' MATERIALS/DEVELOPMENT Gallons of Grout Used: 2 n Casing Type: ❑Well Installation AWell Destruction Blank Feet Screen Feet ❑B Slot Size: oring Installation Boring Destruction Bags Size: Cement: METHOD USED hc) Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b quail Bags gallons Bags Thickest Thinnest »Bags Thickest Thinnest kBags Bentonite/Cement Mix 3%Mix 5%Mix zs 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 10 20 4 1 20 40 4 12.5 1 25 5 L-4 50 5 15 30 6 60 6 17.5 35 7 70 7 20 40 8 00 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 www.sicehd.com