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1�000 SANsJOAQUIN ��, Environmental Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: _ CONSTRUCTION Facility Address: L�d Well Address: 4A Total Depth: WP# 009'773; Well#: Drilling Rig Type: Soil Boring#: 32d–/)(a r�—� Min 2"Annular EHD Seal Verified: EJ Yes ❑No Drilling Company:. Driller Onsite: llGSc,Lih u- tr 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: WT height . WT SAMPLING ABOVE-GROUND Holding Temperature: COh'1iaLETION COMPLETION Method: Ground Surfaon Screening Method: grout Verified Chain of Custody: ❑ Yes El No �tt. tt. SPOILS = o Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: abed Y. _ B sacson Covered: ❑ Yes ❑No _ g.,;w If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: ! n• tt' Grout Material: In cz+^6✓` Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well 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 E Tremie ❑Other: Type of Method: Water Cement 471b water Cement 941b allons Bas gallons Bags Thickest Thinnest 4Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 3% 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 1 60 6 17.5 35 7 35 1 70 7 20 40 8 40 1 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com