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�. fx'� SANvJOAQUIN i� r —courvTY— Environmental Health Department Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Z 20 Inspector: 1 rt6 CONSTRUCTION Facility Address: 13 4T5 I z- Well Address: LLi q�24 Total Depth: WP#�)� � Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No Drilling Company: Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: awn n Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height SAMPLING ABOVE-GRCUNo Holding Temperature: COWLEMN COMP=oN Method: Ground Sudan Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No _L�.ft. ft. n. SPOILS = e Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: abed arc.on — B Covered: ❑ Yes ❑No = l If yes, material: �t- GROUTING or DESTRUCTION Total Depth:�S ' =_ Depth to Water: n n' Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: J D�1v Casing Type: ❑Well Installation ❑Well Destruction 2 � Blank Feet Screen Feet S �\ ❑ 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 Rations 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 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 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.s*cehd.com