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SAN J 0 A 0 U I N Environmental Health Department / —COUNTY %cl Greatness grows here Monitoring Well/Soil Boring Inspection Report Date: �— Z2 26ZOInspe t r: bk� CONSTRUCTION : Facility Addres ( i yv !/S'F Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Drillin g p y:Com an "7lvr-- Min 2"Annular EHD Seal Verified: El Yes El No Driller Onsite:�YYLI Screen Length From: To: Consultant: ?lam Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: W— T height SAMPLING ABOVE-GROUND Holding Temperature: CONFLSrION CCUP�tFnoa Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes El No -�—n' R. tt. SPOILS = Contamination Noted: ❑ Yes ❑No = If yes,spoils storage Location: ato�d soon Covered: ❑ Yes ❑No _ a If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: n- n' Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Use Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: `Gravity ❑Tremie ❑Other: Type of Method: (� Water Cement 47,ib Water Cement 94 lb gallons allons 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 r 25 50 5 15 1 30 6 30 60 6 17.5 1 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.socehd.com