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SAN JOAQUIN y — COUNTY Environmental Health Department Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: y"�'�� Inspector: .461r*'<- CONSTRUCTION Facility Address: Well Address: / 7 S• Total Depth: WP# go 1///SB Well#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes El No Drilling Company: W4rrA.&CJ ,49jSCr4E::� Screen Length From: To: Driller Onsite:1 T Filter Pack From: To: Consultant: 1W Geologist: /t4 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: T height 59 SAMPLING ABOVE-cRCUND Holding Temperature: COWLEr(ON COMPLEMN Method: Ground Svla" If Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �tt' tt. tt. SPOILS = Contamination Noted: ❑ Yes ❑No — If yes, spoils storage Location: slotted on Covered: ❑ Yes ❑No = �v If yes, material: GROUTING or DESTRUCTIONTQtal Depth: !oS Depth to Water: r� tt• tt' Grout Material: jg J& !Sw MATERIALS/DEVELOPMENT Gallons of Grout Used: Z2-f1- � Casing Type: ❑Well Installation QWell 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 IJ remie ❑Other: /4/0: Type of Method: er GenfMit-4Hi5- Water Cement 941b al s allons Bags Thickest Thinnest uBags Thickest Thinnest 1t 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 1111111111161, Wr 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com