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C SAN4JOAQUIN Environmental Health Department " wr`r --COUNTY--- Greatness —COUNTY - Greatness crows her, Monitoring Well/Soil Boring Inspection Report Date:-2,4&3 Inspector: L/ CONSTRUCTION Premise Address: 4�7-7. . 0�'Sy�e-� R.-I WP#: c2p 3,1.r !r �J Total Depth: Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular Seal Verified: ❑ Yes El No Drilling Company: Me4Sc,4 f,.& pAA L�dw Screen Length From: To: Driller Onsite: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height iii SAMPLING AWVE-GROUND Holding Temperature: COWLEMN COMPtETloN Method: G=nd Su1acit Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No —` ft' K. SPOILS = e Contamination Noted: ❑ Yes ❑No — If yes, spoils storage Location: atonaa aec.'on — Covered: ❑ Yes ❑Nogn 1w= t If yes, material: } GROUTING or DESTRUCTION Total Depth: It>o Depth to Water: Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT ,��// Casing Type: I9'Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation ❑Boring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity 1i; remie ❑Other: Type of Method: Water Cement 471b water Cement 94 lb Rall s Bags zallons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags 2.5 5 1 5 10 1 Bentonite/Cement Mix 3% Mix 5% Mix s 10 2 10 20 2 Bentonite per 47 Ib 1.41 2.47 7.5 15 3 15 30 3 10 20 a 20 40 4 Bentonite per 94 Ib 2.82 4.7 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 1 8 1 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 09 468-341.20 1 F 209 464-0138 1 www.sjcehd.com