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N' ) SAN JOAQUIN Environmentai Health Department �9cyFod� ' Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 1l Inspector: Aj CONSTRUCTION Facility Address: C Q� Well Address: td"al Dth: WP# (Db L�t-) 5 Well#: I� Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: Screen Length From:�O To:�,`Z Consultant: Filter Pack From: is, - To:_��• Geologist: Bentonite From: 1 5 To: S( 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 ++ T SAMPLING ABOVE-GROUND Holding Temperature: COWLETION COMPLEnON Method: Ground Surlwe Screening Method: ori Verified Chain of Custody: ❑ Yes ❑No tt. ft. SPOILS Contamination Noted: ❑ Yes El No If yes,spoils storage Location: •b .— B Covered: ❑ Yes ❑No =± — gra vol pad` If yes, material: GROUTING or DESTRUCTION Total Depth: '• __ Depth to Water: tL fL Grout Material: —� MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: /ell Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: I` ressure Grout ❑Over Drill VV - Filter Pack Type/Size: VGravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags 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 50 5 15 3 6 30 60 6 17.5 35 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.swcehd.com