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U�ty�t SAN-JOAQUIN Environmental Health Department R4 ) COUNTY— Greutness grows here. Monitoring Well/Soil Boring Inspection Report Date: /3/2,c Inspector: _&A�r`efi _ CONSTRUCTION Facility Address: Lt`t'S L "(� l 5 O �e C �: ra f It Well Address: V Total Depth: ``Cup WP# Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: El Yes El No Drilling Company: V `4y\j Screen Length From: To: Driller Onsite: 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: CO+"��ION coMPLEnoN Method: Ground Surtaos Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No n. ft. SPOILS = Contamination Noted: ❑ Yes ❑No = r If yes, spoils storage Location: •bttad = - a on x Covered: ❑ Yes ❑No = grz-+Pack If yes, material: =_ GROUTING or DESTRUCTION Total Depth: : - Depth to Water: .Lir Grout Material: A t- MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation 01oring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ GravityTremie ❑Other: Type of Method: waterCem6nt 7tb water Cement 941b allons Bas � allons Bags Thickest Thinnest 9Bags Thickest Thinnest uBags BentonitelGement Mix 3% Mix 5%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 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 40 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com