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SAN J O A Q U I N Environmental Health Department �°-fid � - COUNTY- Greatness grows here. //�� Monitoring Well/Soil Boring Inspection Report Date: '10 Inspector: I'(�( CONSTRUCTION l� Facility Address: WA. P01ttl Well A dress: Total Depth: WP# 00 Al 0 0 141 Well#: Drilling Rig Type: Soil Boring#: — bf Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: rw! Driller Onsite: 1<1 Screen Length From: To: Consultant: du"",QFilter Pack From: To: Geologist: ( 4,( 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: W- T height SAMPLING A8VE.GRCUND Holding Temperature: C014FLErION conioN Method: Ground Surfw* ' + Screening Method: grout Verified Chain of Custody: ElYes ❑No �ft' it. ft. SPOILS a: Contamination Noted: ❑ Yes ❑No — e If yes,spoils storage Location: stotwd a�cion — B Covered: ❑ Yes ❑No = Pack If yes, material: GROUTING or DESTRUCTION Total Depth: 20-Pt :? _ gr"f_ Depth to Water: n• n• Grout Material: Ntat Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation4oring Destruction Bags 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 (6erKent 4 Ib Water Cement 941b allons gallons Bags Thickest Thinnest rrBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 102 10 20 2 7..5 15 3 15 30 3 Bentonite per 94 Ib 2.82 4.7 15 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 30 60 6 17.5 35 7 35 70 7 20 40 8 40 8o 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com