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SAN JOAQUIN Environmental Health Department COUNTY----- Greatness OUNTY---- Greatness grows here. o Monitoring Well/Soil Boring Inspection Report Date: J Inspector: CONSTRUCTIO Facility Address:13oo Well Address: Total Depth: 55 I WP# Well#: Drilling Rig Type: � d "Cl- 1"(Lj ra-�,✓� Soil Boring#: 3- ' 2 �J Min 2"Annular EHD Seal Verified: ❑ Yes El No 0 Drilling Company: Driller Onsite: t Screen Length From: To: Consultant: r 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 ABOVEGROUND Holding Temperature: COMPLETION �t.;_noN Method: G=nd Surface Screening Method: gout Verified Chain of Custody: ❑ Yes ❑No —`--n' ft. ft. SPOILS - Contamination Noted: ❑ Yes ❑No r" If yes, spoils storage Location: clotted _ C sacJon Covered: ❑ Yes ❑No _ g-,el p-k If yes, material: GROUTING or DESTRUCTION Total Depth: IF ' Depth to Water: n' Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet El Boring Installation Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravityfremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb allons Bas gallons Bags Thickest Thinnest sBags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix S% 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 11 1 15 �11 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.slcehd.com