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SAN JOAQUIN Environmental Health Department —COU NTY-- P Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: l - _ Inspector: 'S ulq, H JA CONSTRUCTION Facility Address: Pt-h CYanhYw Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: El Yes 1:1 No Drilling Company: Screen Length From: To: Driller Onsite: Consultant: Y1 vtkL Filter Pack From: To: Geologist: Y Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes E]No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: CONFLETION Ca�>=nON Method: Ground Surface Screening Method: grota Verified Chain of Custody: ❑ Yes ❑No tt. SPOILS = Contamination Noted: ❑ Yes ❑No = e If yes, spoils storage Location: stoned sacdon — Covered: ❑ Yes ❑No If yes, material: fix: GROUTING or DESTRUCTION Total Depth:2 AGI Depth to Water: — n• n' Grout Material: N eA:t a W�k Ot MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: []Boring Installation ]Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: 1I Gravity ❑Tremie ❑Other: Type of Method: Water ement 471b Water Cement 941b allons iRaill ons Bags Thickest Thinnest aBags Thickest Thinnest 4Bags 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 40 80 1 8 N 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