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SANsJOAQUIN Environmental Health Department c { COUNTY- Greatness OUNTY-Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 3-19-7oza Inspector: CONSTRUCTION Facility Address: %C.- /u,•/C ltvre Well Address: Total Depth: d1f WP# 6y yo bo/ Well#: Drilling Rig Type: Soil Boring#: C-F-'ZO - 03 Drilling Company: Gam-6A "114-e Min 2"Annular EHD Seal Verified: ❑ Yes El No Driller Onsite: Screen Length From: To: Consultant: V-S Filter Pack From: To: Geologist: �w�- Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes 0 N COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height iii SAMPLING ABOVEGROUND Holding Temperature: CONFLETION cD&*n_EncN Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes El No �ft. ft. ft. SPOILS = Contamination Noted: ❑ Yes El No — If yes,spoils storage Location: .toad K' a�cson — B Covered: ❑ Yes ❑Nogni= ve,> If yes, material: GROUTING or DESTRUCTION Total Dept Depth to Water: -sC -� r w+�U- n• — tt- Grout Material: tet, MATERIALS/DEVELOPMENT Gallons of Grout Used: -_ Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: W r nt 4 b Water Cement 941b Bas gall ons 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 5 25 50 5 15 30 6 30 1 60 6 17.5 35 7 35 1 70 7 20 40 8 40 80 6 6-0 10 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sFcehd.com