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SAN JOAOUIN Environmental Health Department !_ah_ COUNTY—Greatness grows he;,, Monitoring Well/Soil Boring Inspection Report Date: J015-fir Inspector: .oevw� CONSTRUCTION ll✓ Facility Address: 22vi )&A/4 Ad Well Address: Total Depth: i WP# 6g� 3W2Well#: Drilling Rig Type�� 6 73 Soil Boring#: A). Z. X Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: �-'��-� Driller Onsite: "� Screen Length From: To: Filter Pack From: To: Consultant: 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: WT height SAMPLING ABOVEGROUND Holding Temperature: COWLETION COMPLEMN Method: Ground S"f"' Screening Method: Grout Verified Chain of Custody: ❑ Yes El No �ft. ft. SPOILS = Yw = e Contamination Noted: ❑ Yes ❑No — If yes, spoils storage Location: stoned = socton — 8 Covered: ❑ Yes ❑No = 1101 v ack If yes, material: GROUTING or DESTRUCTION Total Depth: 2 — Depth to Water: 44b G.J ft• n' Grout Material: Neal GPS' MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation XBoring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie XOther: -40° Type of Method: ate ent Ib Water is all Bas allons Bags Thickest Thinnest ttBags Thickest Thinnest Bentonite/Cement Mix 3% Mix 55%Mix 2.5 5 1 5 10 Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 10 20 4 20 40 12.5 25 5 25 50 15 30 6 30 60 17.5 35 7 35 70 20 40 8 40 80 ,w 32, 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com