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SKJOAQUIN Environmental Health Department f —COUNTY— Greatness grows here Monitoring Well/Soil Boring Inspection Report Date: 9/l/ Inspector: W Facility Address: '3Z Al jj,%pV1/dj Well Address: Thickest Thinnest WP# 3 '�3 C, Well#: Soil Boring#: Drilling Company: To: Driller Onsite: Filter Pack From: Consultant: oc Geologist: 1 1 1 /–t'm (,1eI Public Water System Onsite Domestic Well Onsite If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method:_ Verified Chain of Custody: SPOILS Contamination Noted: If yes, spoils storage Location: Covered: CONSTRUCTION Total Depth: � 0 Ll ff n Drilling Rig Type: Cement 94 lb Bags Thickest Thinnest Min 2" Annular EHD Seal Verified: ❑ Yes El No rt Bags Screen Length From: To: 1 Filter Pack From: To: 5 Bentonite From: To: 10 20 Grout From: To: 15 ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box ❑ Yes ❑No ❑ Yes ❑No ❑ Yes ❑No ❑ Yes ❑ No If yes, material: GROUTING or DESTRUCTION Total Depth: 0 Depth to Water: N % A Grout Material: —"L_r rzwa' Gallons of Grout Used: ❑Well Installation ❑Well Destruction ❑Boring Installation ❑Boring Destruction METHOD USED ❑Pressure Grout ❑Over Drill ❑ Gravity ❑Tremie ❑Other: Water allons Cement 471b Bas Water gallons Cement 94 lb Bags Thickest Thinnest uBags Thickest Thinnest rt Bags 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 casing height ABOVE -GROUND CtWsm-Box COMPLETION COMPLETION Ground sumacs grout n. ff. tt. _ e — o slonad soon — cn+o+ pack 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 L/ t 3A A"'s -k. 4 b � 5 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 10/16/2017 www.smcehd.com