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SAN JOAQUIN Environmental Health Department ` ---COUNTY-- °q�jP' Greatness grows here. FO- Monitoring Well/Soil Boring Inspection Report Date:SI ZO inspector: 07'-i O�- A4�'4�"�CONSTRUCTION Facility Address: 2� w- o.jn Well Address: / Total Depth: WP#tea L11)4 Well#: ed WE– Drilling Rig Type: Soil Boring#: Drilling Company: Colrrp/� LONt��ej Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Driller Onsite: /1/j; 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 ABOVE-GROUND Holding Temperature: CONFLETION CCOMP�LETION Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes El No M tt. tt. SPOILS Contamination Noted: ❑ Yes El No a` _ If yes, spoils storage Location: slotted astcion ' — Covered: ❑ Yes ❑No -7 g pack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: n' Grout Material:_ P,O� MATERIALS/DEVELOPMENT Gallons of Grout Used: qo.,( 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 *remie ❑Other: Type of Method: Water Cement 471b Water Ceme 941b allons Bas eallons Bags Thickest Thinnest 1t Bags Thickest Thinnest tlBags Bentonite/Cement Mix 3% Mix %M 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 1 40 8 40 80 8 S� 9 a-5 bno 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.smcehd.com