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SANJOAHIN Environmental Health Department COUNTY— s;,; n Greatness grows here. 1 / Monitoring Well/Soil Boring Inspection Report Date: I 1� `� Inspector: 1 ) CONSTRUCTION Facility Address: �D � '9 Well Address: `� Total Depth: WP# p,? 4-0 1 T Well#: Drilling Rig Type: Gy u e S Soil Boring#: q - -Z 5Z 1�-3s %)1-Lt Drilling Company:. Min 2" Annular EHD Seal Verified: El Yes El No Driller Onsite: Sgl1`-5 Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes EJ No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION =mPLEnoa Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No ft. tt. ft. SPOILS Contamination Noted: ❑ Yes El No If yes, spoils storage Location: slated s*cdon Covered: ❑ Yes ❑No ` Sxawl pa k If yes, material: GROUTING or DESTRUCTION Total Depth:_ =_ Depth to Water: n- M Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation /oring Destruction �j'' �� Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Dkravity ❑Tremie ❑Other: Type of Method: Water Cement 47 lb Water Cement 941b Ilons Bas eallons Bags Thickest Thinnestar Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 3% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 10 204 20 40 4 12.5 25 5 25 5o 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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com