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SAN,JOAQUIN Environmental Health Department COUNTY - Greatness OUNTY - Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 3 fidd Inspector: CONSTRUCTION Facility Address: J12Q tZ' ( ce_A,�, Well Address: Total Depth: WP# e'35.t„� Well#: �✓��(� Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Screen Length From: To: Driller Onsite: Filter Pack From: To: Consultant: Bentonite From: To: Geologist: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COWLON cowLEnoN 1=I Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes EI No �ft• n. ft. SPOILS = Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: slotted sac on Covered: ❑ Yes ❑No = amw+Pack If yes, material: _ GROUTING or DESTRUCTION Total Depth:790 Depth to Water: n• M. Grout Material: Gallons of Grout Used:0-ld MATERIALS/DEVELOPMENT Casing Type: ❑Well 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: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ElGravity I; remie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb allons Bas gallons Bags Thickest Thinnest ttBags Thickest Thinnest 4Bags 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 5w- 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 ,2,1 st/ 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