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SAN J OAQ U I N Environmental Health Department -.! --C OU N TY---- Greatness Y----Greatness grows herr, Monitoring Well/Soil Boring Inspection Report Date: � Inspecto _ atky Pt CONSTRUCTION Facility Address: Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Drilling Company: I f IV Min 2" Annular EHD Seal Verified: ElYes ❑No G Driller Onsite: T Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Yfa1� 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: W— T height SAMPLING ABVE-GROUND _ Holding Temperature: CONFLE ION CCOMPLEnoN Method: Ground Surfacs Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �ft• s. n. SPOILS = o Contamination Noted: ❑ Yes El No = If yes, spoils storage Location: sbio wc9on _ $ Covered: ❑ Yes ❑No _ vim* If yes, material: GROUTING or DESTRUCTION Total Depth:-2-04-t _ Depth to Water: n — n Grout Material: NI?a-r Ce,rVIS Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring InstallationNBoring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb gallons Bas gallons Bags Thickest Thinnest »Bags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 30 6 30 60 6 1 s 35 7 35 70 7 3 bo� c J t 9' 10 900 FIS via 20 40 8 40 80 8 (Li1 u) 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com