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/o�;iau+ro c., <' SANjJOAQUIN Environmental Health Department —COUNTY-- Greatness COUNTY — Greatness grows herd, Monitoring Well/Soil Boring Inspection Report Date: Inspector: Tar ' Vc) CONSTRUCTION Facility Address: Well Address: <<.2-" Total Depth: WP#__(Cb i n�_30 Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No Drilling Company: U=esl Ex-, 4 Exilwl 4)41 Driller Onsite: Screen Length From: To: 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: COMPLETION ccOMPLEnON Method: Ground S"t"' Screening Method: grout Verified Chain of Custody: ❑ Yes El No ft. SPOILS n. ft. SPOILS = GK vd` _ O Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: alottad .on Covered: ❑ Yes ❑No Qrsvw Pack If yes, material: A _= GROUTING or DESTRUCTION Total Depth: 4. — Depth . —Depth to Water: '1 n• ft. Grout Material: �'j GA MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation ❑ Slot Size: Boring Destruction Bags Size: 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 471b Water Cement 941b allons Bas Vallons Bags Thickest Thinnest 9Bags 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 15 30 3 10 20 4 20 40 4 12.5 1 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com