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SAN JOAQUIN Environmental Health Department COUNTY Greotness grows here Monitoring Well/Soil Boring Inspection Report Date: 1 Inspector: CONSTRUCTION Facility Address..sw,unix OF r4ylt J I1r1/,�'ayisrwAM Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: R D°i Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Compa Driller Onsiten: S Screen Length From: To: Consultant:. 11_� Filter Pack From: To: Geologist: t1 Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: WT height SAMPLING ABOVE-GROUND Holding Temperature: �^F��N c1FncN Method: Ground Surf'`' Screening Method: Grout Verified Chain of Custody: ❑ Yes El No 4r —ft. ft. ft. SPOILS Contamination Noted: ❑ Yes []No — If yes, spoils storage Location: slotted sac9on — � Covered: ❑ Yes El No = Gnw+ If yes, material: r' GROUTING or DESTRUCTION Total Depth: =20 T)01 �5 -�: = 1 — tt. Depth to Water:—" n• Grout Material: IsSea� MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installationoring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity �ITremie ❑Other: Type of Method: Water II`` n 171b Water Cement 94 lb allons Bas gaill ons Bags Thickest Thinnest s Thickest Thinnest It Bags 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 so 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 90 8 10/16/2017 390b'a' walfA W C�nru At 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com