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=°Pa °� SAN�JOAQUIN Environmental Health Department I.".JQk —COUNTY— `�°��1FosaP Greatness grows here. --7 f Monirt�orri�ng�Wgeell/Soil Boring Inspection Report Date: / 3/ I Inspect= � "k�"'V� 'C�1 CONSTRUCTION � p U� �-,� Facility ddress: )115-q A-lr1S —J `I I Z � / i �U K Wellddre Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Compan Screen Length From: To: Driller Onsite: 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 AsovE-GROUND Holding Temperature: COMPLETION COMPLETION Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �ft. ft. ft. SPOILS Contamination Noted: ❑ Yes El No r` _ C If yes, spoils storage Location: slotted sac7on Covered: ❑ Yes El No _ VI+v If yes, material: p Cp P,L� GROUTING or DESTRUCTION Total Depth: a� Depth to Water: n• tt. Grout Material: N'aQ _ml ri- Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet El Boring Installation INIhoring Destruction Slot Size: Bags of 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 ement 471b Water Cement 941b allons I Bas gaill ons Bags Thickest Thinnestags Thickest Thinnest ttBags 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 C t 15 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com