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i�o!Qu!N co f? t- SANoJOAQUIN Environmental Health Department CNTY c�« T! Greatness grows here Monitoring Well/Soil Boring Inspection Report Date: -7-31-4�70 Inspector: CONSTRUCTION Facility Address: 3 E ft '4:je� Well Address: Total Depth: WP#'t'VH'0 jq7 Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes EJ No Drilling Company: 'ut) Driller Onsite: ziHa Screen Length From: To: Cor�rft�nt: Filter Pack From: To: G Ist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ZNo COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: WT height SAMPLING ABOVE-GROUND Holding Temperature: CONPLETION COMPLETION Method: G=nd Scrlacs Screening Method: ole Verified Chain of Custody: ❑ Yes El No n. ft. SPOILS ; = e Contamination Noted: ❑ Yes ❑No — C If yes, spoils storage Location: slon2d aeon — B Covered: ❑ Yes ❑No = � If yes, material: r GROUTING or DESTRUCTION Total Depth: 32oOP _ Depth to Water: n n' Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Gy 8'J�-u Cfiws Casing Type: I Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction ✓f� L Bags of Cement: METHOD USED b'� el dT Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Idf' 6`15Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest 9Bags Thickest Thinnest It 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 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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com