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9-1.4 SAN JOAQUIN t�—COUNTY— . Greotness gror:s Ferc. Environmental Health Department Monitoring Well/Soil Boring Inspection Report Dater t q A 19 Inspector: Vj Yyt� Facility Address: % Z)6-6 0 +-td Well Address: w , 5. WP# " i Well#: Soil Boring#: . C w ?— Drilling Company: Driller Onsite: It5v b b Consultant: 4� Geologist: Public Water System Onsite: ❑ Yes r4N0 Domestic Well Onsite: ❑ Yes MNo If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method: Verified Chain of Custody: ❑ Yes ❑No Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: ti _ Depth to Water: S Grout Material: Gallons of Grout Used: ❑Well Installation ❑Well Destruction— ❑Boring Installation>�Boring Destruction METHOD USED ❑Pressure Grout ❑Over Drill ❑ Gravity Nremie ❑Other: Water allons Cement 471b Bas Water gallons Cement 941b Bags Thickest Thinnest tte Thickest Thinnest q Bags 2.5 5 1 5 10 1 5 10 10 20 2 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 8 CONSTRUCTION Total Depth: _ Drilling Rig Type: Min 2" Annular EHD Seal Verified: ❑ Yes El No Screen Length From: To: Filter Pack From: To: Bentonite From: To: Grout From: To: COMPLETION ❑ Stove Pipe ❑Christie Box M MATERIALS/DEVELOPMENT Casing Type: Blank Feet Slot Size: Bags of Cement: Bags Sand/Gravel: Type/Brand of Bentonite: Filter Pack Type/Size: Type of Method: Screen Feet Bentonite/Cement Mix 3% Mix 5% Mix Bentonite per 47 Ib 1.41 2.47 Bentonite per 94 Ib 2.82 4.7 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com