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SAN JOAQUIN Environmental Health Department ---COUNTY— Greatness —COUNTY---Greatness grows here. Monitoring Well/Soil Boring Inspection Report " U /I Date: I 20 Inspector: A CONSTRUCTION (' —2 L S 20^�i7 Facility Address: S 9 S t7 Woo d b,-,'dei It`s`' Well Address: Total Depth: /lu WP# 0c7 Well#: Drilling Rig Type: Soil Boring#: 5 B — Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company:. , Ckt4— S Screen Length From: To: Driller Onsite: Consultant: �7 D- �o L S q.,,4Filter Pack From: To: Geologist: /�- p„h,'Qr Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: ITTLT height SAMPLING ABOVE-GROUND Holding Temperature: COAFLErION CWPLEnoN Method: Ground S"rfws Screening Method: grout Verified Chain of Custody: ❑ Yes L1 No �f• tt. ft. SPOILS = Contamination Noted: ❑ Yes El No If yes, spoils storage Location: slatted soman Covered: ❑ Yes ❑No =: = e,,,el pack 4 If yes, material: GROUTING or DESTRUCTION Total Depth: S� ''• =_ Depth to Water: W V7 n' n' Grout Material: _ L MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity KTremie ❑Other: Type of Method: Water Cement 71b Water Cement 941b allons Bas allons Bags Thickest Thinnest 1t Bags Thickest Thinnest +!Bags Bentonite/Cement Mix 3% Mix 3%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 15 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 Qc 9 C', Q�� (910/16/2017 1868 E. Hazelton Avenue St6cktoJn, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com