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SAN JOAQUIN Environmental Health Department COUNTY— , Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date:�1 inspector: 1'i ►�s CONSTRUCTION Facility Address: _2A / vl au h S Well Address: Total Depth: WP# 00 Well#: Drilling Rig Type: Soil Boring#: V'o-Co P1Min 2" Annular EHD Seal Verified: E] Yes ❑No Drilling Company: �i^ Driller Onsite: Screen Length From: To: Consultant: -Fe- rro C0✓� Filter Pack From: To: Geologist: Bentonite From: To: �V' S Grout From: To: Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COWPLE oN Co4a+P�ienON Method: G=nd Surface Screening Method: trout Verified Chain of Custody: ❑ Yes ❑No �tt' ft. ft. SPOILS - '— Contamination Noted: ❑ Yes El No =" _ If yes,spoils storage Location: abed aae�on = 3 Covered: El Yes ❑No =' craw++pack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: n- Grout Material: Nem MATERIALS/DEVELOPMENT Gallons of Grout Used: a'Z s 4 0-1 Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet []Boring Size: Boring Installation rABoring Destruction Bags Size: 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 941b allons Bas gallons Bags Thickest Thinnest 2Bags Thickest Thinnest 4Bags 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 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 904 9h� ! �a�S 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com