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SAN JOAQUIN Environmental Health Department --COUNTY-- -- s;;`;�N`' Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: I Zl/l F Inspector: oLro0, TP VI fi b' CONSTRUCTION Facility Address:A,Y1('it- 4v/- Well Address: Total Depth: WP#CO qo i Well#: Drilling Rig Type: Soil Boring#: 02 Min 2" Annular EHD Seal Verified: ❑ Yes El No Drilling Company: e) < < Driller Onsite: ' S Screen Length From: To: Consultant: 6L K Filter Pack From: To: Geologist: co,r-Vtvt Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION CCOOMPLETION Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes El No �--n' n. n. SPOILS = Contamination Noted: ❑ Yes ❑No = If yes, spoils storage Location: sbn�d sacJon Covered: ❑ Yes ❑No _ If yes, material: GROUTING or DESTRUCTION Total Depth: 2 - Depth to Water: N,, W1' t— 61 n. Grout Material: Gallons of Grout Used: 5'kMATERIALS/DEVELOPMENT '_ �, Casing Type: E]Well Installation ❑Well�esstruct n Blank Feet Screen Feet Slot Size: ❑Boring Installation MBoring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: 75LGravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb allons Bas eallons Bags Thickest Thinnest #Bags 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 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 1 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 �� bD� l 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s'cehd.com