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SAN JOAQUIN Environmental Health Department COUNTY Greotness grows here. Monitoring Well/Soil Boring Inspection Report Date: 7—'1y-t j Inspector: t0'stz"^ CONSTRUCTION Facility Address: S't35" 410X-I'cb Well Address: Total Depth: WP#t,,Q.3'rq`161 3yH.6'/ Well#: 1, Z Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: �sr^^'�!y Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: 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: height SAMPLING ABOVE-GROUND Holding Temperature: COWLEriON COMPLEnoiV Method: around S"r1"' Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �ft' ft. ft. SPOILS = o Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: sat.on — S Covered: ❑ Yes ❑No _ = grz,�W p..k If yes, material: _ GROUTING or DESTRUCTION Total Depth: 11 -_ Depth to Water 13 n• n' Grout Material: NdAk «'W" Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: CAWell Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie Other: frt4l�14 Type of Method: at ent 471 Water Cement 94 lb ns Basgallons Bags Thickest Thinnest 4Bags 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 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 -J t-X6 10/16/2017 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com