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° SAN JOAQUIN 1� Environmental Health Department —COUNTY— Greatness grows here Monitoring Well/Soil Boring Inspection Report Date: ko I i i-2,k,l Inspector: `Crt+_iisk, SaetPrn CONSTRUCTION Facility Address: F\coc\ Well Address: Total Depth: WP# o Q40c.)8.2 Well#: Drilling Rig Type: Soil Boring#: xc\ Min 2" Annular EHD Seal Verified: 11 Yes ❑No Drilling Company: kra zcan flscrci 1r,c Screen Length From: To: Driller Onsite: (''V-Tp < . Filter Pack From: To: Consultant:�ro,�ar, � �,oCfcAA-S. \rc ��L1Y2 Bentonite From: To: Geologist: Grout From: To: Public Water System Onsite: ❑ Yes No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COWLETION G _OMPPLEMN Method: Ground Surf=* Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No ft. ft.ft. ft. SPOILS = Contamination Noted: ❑ Yes El No If yes, spoils storage Location: abed n y, _ Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth:�� Depth to Water: Nome t<. IF n' Grout Material: ia2ar C-omen V MATERIALS/DEVELOPMENT Gallons of Grout Used: 15 Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation oring 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 Cement 471b Water Cement 941b allons Bas oallons Bags Thickest Thinnest 1t 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 15 30 3 10 204 20 40 4 12.5 25 5 25 50 5 35 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com