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SAN�,JOAQUIN Environmental Health Department COUNTY-- Greotness grows here. Monitoring Well/Soil Boring Inspection Report Date: 1 IL ZO W inspector:p I II iyio- 5 CONSTRUCTION Facility Address: Well Address: 3• 34 S_ MGLr\ Total Depth: WP# ( 0'A Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: EJ Yes El No Drilling Company: OC-0 CA , jf�f� ,l Driller Onsite: TCS �creen Length From: To: Consultant:" ' 'tet 1,n "wT41C 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: ITTLT height R ff-- —Crr—f SAMPLING ASOVE-GROUNo Holding Temperature: COLVILETION COMP�LEnON Method: Ground Surface Screening Method: Aran Verified Chain of Custody: ❑ Yes ❑No tt. tt. SPOILS Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: stoned s*c-jon Covered: ❑ Yes ❑No = 9-VIW pock If yes, material: GROUTING or DESTRUCTION Total Depth: y5 Depth to Water: NP LN'—at,tt- tt' Grout Material: jl�eLI-aiyyw4- MATERIALS/DEVELOPMENT Gallons of Grout Used: 16 jjaIIonS Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: P�Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest 0Bags 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 Sentonite 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com