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S A N J 0 A Q U I N Environmental Health Department --COUNTY-- Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: ��`✓t� CONSTRUCTION Facility Address: Well Address: d h l�v�rZ /� Total Depth: WP# Do 4 6 11' Well#: f Drilling Rig Type: Soil Boring#: Drilling Company: l i w W� , Min 2"Annular EHD Seal Verified: E] Yes ❑No Driller Onsite: CoAki 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: height SAMPLING Asove•GRCUND Holding Temperature: COMPLETION CCWLEnoN Method: GroundSulac* "'+ Screening Method: R grout Verified Chain of Custody: ❑ Yes ❑No —n' ft. SPOILS Y.. Contamination Noted: ❑ Yes El No If yes,spoils storage Location: socdon — B Covered: El Yes ❑No = g-VW Pack If yes, material: % GROUTING or DESTRUCTION Total Depth: : Depth to Water: ++ n• tt• Grout Material: iL& {61 S1 �l Gallons of Grout Used: '`� 2 �(ow1: 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 I$Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gall ons Bags Thickest Thinnest 4Bags Thickest Thinnest NBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 s 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 z 10 20 z 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 50 5 2 bays � y 6/oU f � e /I DP 25 l `/ 1 1 . 30 35 7 30 70 7 05 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.socehd.com