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Z SAN_JOAQUIN Environmental Health Department —COUNTY-- Greatness COUNTY—Greatness grows here Monitoring Well/Soil Boring Inspection Report Date: \2 2� -Zo Inspector: e Ih0.5 CONSTRUCTION Facility Address: S 1'Plhbr'� 7f . i Well Address_ Total Depth: WP# kjr4-+0 Well#: Drilling Rig Type: Soil Boring#: g4 Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Tewtkwn Driller Onsite: 10oar\rl 4Screen Length From: To: Consultant: 'C (oV-N Filter Pack From: To: Geologist: "LCAL GefgLtSA Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING AsovE.GROUNo _ Holding Temperature: CONFLETION COMPTMLETtoN Method: Ground Surl=* Screening Method: Oram Verified Chain of Custody: ❑ Yes El No �ft- tt. ft. SPOILS = Contamination Noted: ❑ Yes El No If yes, spoils storage Location: sbned a�cson '— Covered: ❑ Yes ❑No _ _ 9-viw pack If yes, material: _= GROUTING or DESTRUCTION Total Depth: Depth to Water: No, tt• tt. Grout Material: N e&f Ct°a►'4lf. MATERIALS/DEVELOPMENT Gallons of Grout Used: 114 �kr\ Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation XXBoring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb allons Bas eallons Bags Thickest Thinnest ltBags Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5%Mix 2.5✓ 5 1 v 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 a/ 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.sacehd.com