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SANJOAQUIN —COUNTY--- `;,;". Greatness grows here. Environmental Health Department Monitoring Well/Soil Boring Inspection Report Date: J 2— % Inspector: Facility Address: ;27g 6rUY2Ay,1jUk Well Address: WP# 003 (o Well#: Soil Boring#: Drilling Company: kref2A4n, Driller Onsite: Consultant: Geologist: Public Water System Onsite: ❑ Yes El No 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: If yes, material: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ENO ❑ Yes ❑No GROUTING or DESTRUCTION Total Depth: Depth to Water: N ID ElV% Grout Material: Wim+ Gallons of Grout Used: ❑Well Installation ❑Well Destruction ❑Boring Installation'�Boring Destruction METHOD USED // ❑Pressure Grout ❑Over Drill %Gravity ❑Tremie ❑Other: Waterement allons 471b a s Water allons Cement 941b Bags Thickest Thinnest trBags Thickest Thinnest NBags 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 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 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 3 0 � ba� 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