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U11 SAN J O A Q U I N Environmental Health Department COUNTY - Sq r/ Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: / CONSTRUCTION Facility ddress: q 9S Sfjr A4 Well Address: Total Depth: �S A til WP# 00 qOH Well#: Drilling Rig Type: ft Soil Boring#: (� Drilling Company: COP-S X p T�flH Min 2"Annular EHD Seal Verified: El Yes ❑No Driller Onsite: Q,G ik Screen Length From: To: Consultant: 5 p, S rL 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 —CWT SAMPLING ABOVE-GROUND Holding Temperature: OOi4�LEftON ccooMP�LEnooN Method: Ground Surlaics Screening Method: grout Verified Chain of Custody: ❑ Yes El No -ft. tt. tt. SPOILS Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: 02 stottQd g5 aK}on Covered: ❑ Yes ❑No ?j = graviWpack If yes, material: 6q '40 i — GROUTING or DESTRUCTION Total Depth:1f 8 S��, • Depth to Water: 19 , Grout Material: _ Gallons of Grout �Used: MA nERALS/ EVELOPMENT�� g Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation Boring Destruction gags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: SGravity ❑Tremie ❑Other: Type of Method: Water Cement I Water Cement 941b allons Bas aallons Bags Thickest Thinnest #Bags Thickest Thinnest 9Bags 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 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 1 35 7 35 70 7 20 1 40 8 40 80 8 --j� q�' IV 10/16/2017 171868 E. Hazelton Avenue S Ckton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com