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SANSJOAQUIN Environmental Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Vic) iJ Inspector: c . CONSTRUCTION Facility Address: Well Address: I L S Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Z Drilling Company: \/SIO P WA)Q[) Q.I I -I -IMG Cp Min 2" Annular EHD Seal Verified Driller Onsite: `il.I/�tjJ Screen Length From: Filter Pack From: Consultant: Geologist: D ("�� Bentonite From: Grout From: Public Water System Onsite Domestic Well Onsite If yes, location and distance: SAMPLIN Holdin emperature: Met d: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑ Yes ❑No Zerif ening Method: ied Chain of Custody: ❑ Yes ❑No M0,41110 Contamina ' n Noted: ❑ Yes El No If ye /,spoils storage Location: I ed: ❑ Yes ❑ No / If yes, material: n GROUTING o DESTRUCTION otal Depth: 9 l� 5 Depth to Water: Z ,! Grout Material: U rEANAf2-0 Gallons of Grout Used: n ❑ Yes ❑No To: To: To: To: ❑Christie Box Casing Type: ❑Well Installation ❑Well Destruction Blank Feet ❑Boring Installation .Boring Destruction METHOD USED El Pressure Grout ❑Over Drill 10 Gravity ❑Tremie ❑Other: Water allons Cement 471b Bags Water @lions Cement 94 lb Bags Thickest Thinnest #Bags Thickest Thinnest #Bags 2.5 5 1 5 10 1 s 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 a 40 eo 1 e Slot Size: Bags of Cement: Bags Sand/Gravel: Type/Brand of Bentonite: Filter Pack Type/Size: Type of Method: ft. Screen Feet BentoniteXement 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com