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SAN,-JOAQUIN Environmental Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Vt Inspector:aLQX27j^ CONSTRUCTION Facility Address: ',OtQ vJ . L%e-4—�`Q 2ArA, Well Address: Total Depth: WP# `k."1 Well#: Drilling Rig Type: Soil Boring#: �►'p�/'�Ce�Cs� Min 2"Annular EHD Seal Verified: El Yes ❑No Drilling Company: Driller Onsite: Screen Length From: To: Consultant: I(�,�c..�o� Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: VJ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes [�`No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION COMPLETION TI Method: Grocrnd Surface Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No - -n' tt. ft. SPOILS m = a Contamination Noted: ❑ Yes ❑No a` If yes, spoils storage Location: sranad - sacdon Covered: Yes ❑No — Ifyes, material: GROUTING or DESTRUCTION Total Depth: • =_ Depth to Water: ' Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction gags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gallons Bas gallons Bags Thickest Thinnest tlBags Thickest Thinnest #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 z 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 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com