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A( :opdum SANJOAQUIN Environmental Health Department —COUNTY--- Greatness COUNTY--- Greatness grows here Monitoring Well/Soil Boring Inspection Report Date: <<► Inspector: CONSTRUCTION Facility Address: L -j Cement 47 lb Bas Well Add W Total Total Depth: 4,> 0. WR# Well#: Drilling Rig Type: Thickest Thinnest Soil Boring#: 5 2.5 5 Drilling Company: � V Min 2" Annular EHD Seal Verified: ❑ Yes El No Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: oA6 Bentonite From: To: 15 Grout From: To: Public Water System Onsite Domestic Well Onsite If yes, location and distance: SAMPLING Holding Temperature: Method: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box ❑ Yes []No Screening Method: Verified Chain of Custody: ❑ Yes El No SPOILS Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Covered: ❑ Yes ❑ No If yes, material: GROUTING or DESTRUCTION Total Depth:�� Depth to Water: r, , A Grout Material: C -I 44 Gallons of Grout Used: I— ❑Well Installation ❑Well Destruction ❑Boring Installation ❑Boring Destruction METHOD USED ❑Pressure Grout ❑Over Drill #ravity OTremie ❑Other: Water allons Cement 47 lb Bas Water allons Cement 941b Bags Thickest Thinnest BBags Thickest Thinnest 9Bags 2.5 5 1 5 10 1 5 10 2 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 ft. 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 Sentonite/Cement Mix 3% Mix 5% Mix Bentonite per 47 Ib 1.41 2.47 Bentonite per 94 Ib 2.82 4.7 ow t 5541(�s eI4 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com