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SAN JOAQUIN g Environmental Health Department --COUNTY- C' COUNTY-` Greatness grows here. 22 Monitoring Well/Soil Boring Inspection Report Date: 6/ 6 Inspector: CONSTRUCTION U I t Facility Address: ►' kd( G Well Address: Total Depth: WP# 00=z _Well#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: Screen Length From: To: Consultant: 5LeraCP_ / Filter Pack From: To: � Bentonite From: To: Geologist: EK11 k 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 ABOVE-GROUND COMPLETION Ct4iiSTY-80X Holding Temperature: COMPLE 1ON Method: Ground Surtoce Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �tt' tt. tt. SPOILS Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: atoned aec%on — Covered: ❑ Yes ❑No - _- 2a„W If yes, material: _ GROUTING or DESTRUCTION Total Depth: j✓ Depth to Water: Grout Material: n;o`O MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: _ El Boring Installation Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b water Cement 941b allons Bas izallons Bags Thidest Thinnest t7 Bags 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 15 30 3 10 20 QiU 20 40 4 12.5 25 5 -5 50 5 15 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 slcehd.com