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P, o ( /Pc2 SAN��JOAQUIN Environmental Health Department i" 1 ` —COUNTY----- Greatness COUNTY-- Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Q IG(U20 Inspector: ikv%vy C) CONSTRUCTION Facility Address: Well Address: A6,ftffVeq JU Total Depth: WP# Z Well#: J Drilling Rig Type: Soil Boring#: � Min 2"Annular EHD Seal Verified: El Yes El No Drilling Company: bx. Driller Onsite: '1Screen Length From: To: Consultant: �1Sem �Y�. W#V!4 Yi (5 P Filter Pack From: To: Geologist: ?-QbQh . 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 COMPLETION Method: around Surfak@ +�'�—� Screening Method: ori Verified Chain of Custody: ❑ Yes ❑No —n' tt. tt. SPOILS a: Contamination Noted: ❑ Yes El No r" If yes, spoils storage Location: slottaa .on Covered: ❑ Yes ❑No = „W Pack If yes, material: •Y GROUTING or DESTRUCTION Total Depth:. =_ Depth to Water: (��(��1 � Y• n- — n' Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: IS k 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 ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons 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 1 Bentonite per 94 Ib 2.82 4.7 7.5 15 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.secehd.com