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-� , SAN JOAQUIN Environmental Health Department COUNTY Greotness grows here Monitoring Well/Soil Boring Inspection Report Date: 2 Inspector: t nW) CONSTRUCTION Facility Address: tk V1 3t. st (.Nlvn Well Address: _ Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Drilling Company': anY Min 2"Annular EHD Seal Verified: ❑ Yes El No Driller Onsite: Screen Length From: To: Consultant: � �, 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: height SAMPLING AWVE-GROUND Holding Temperature: COMPLETION cCC#APLEnCN Method: Ground Surface Screening Method: ori Verified Chain of Custody: ❑ Yes El No ft. ft. SPOILS >v = o Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Slott" sic:ion _ Covered: ❑ Yes ❑No = s If yes, material: _ _= GROUTING or DESTRUCTION Total Depth: \54. =_ Depth to Water: Nb Grout Material: 1J(ja1 - Cer✓\0_A.1r Gallons of Grout Used: �qcL\, MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Size: ❑Boring Installation 74oring Destruction Bags Slot Siziz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: El Pressure Grout ❑Over Drill Filter Pack Type/Size: 9"ravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest PBags Thickest Thinnest JlBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 2 ✓ 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 10 20 4 v' 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 209 468-34201 F 209 464-0138 1 www.s*cehd.com