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"`"`� SAN JOAQUIN u 2 Environmental Health Department —COUNTY -- oy� r/ Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: �- 2pZ1 Inspector: l CONSTRUCTION Facility Address:_ Y `Q W0.1/1 I .t1 Well Address: W`P O U s lQ 6 J Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Drilling Company: of f. juQk Ink y\0 Min 2"Annular EHD Seal Verified: El Yes ❑No Driller Onsite: Screen Length From: To: Consultant: &-f- U0 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: T height iii SAMPLING ABOVE-GROUND Holding Temperature: COWPLEriON CO�MP�LETtoN Method: Ground Surface Screening Method: Grout Veriflied Chain of Custody: ❑ Yes ❑No �_tt• rt. SPOILS 14- e Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: slotted soon Covered: El Yes El No y = graw+pack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: n' Grout Material: �P 1 MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation�BOringDestruction � bQ Slot Size: Bags of Cement: METHOD USED �41 Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity I<Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest uBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 s 2 10 20 2 Bentonite 94 Ib 2.82 4.7 7.5. 15 3 15 30 3 10 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.smcehd.com