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� � SANsJOAQUIN Environmental Health Department COU NTY— `Ot ��/ Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Okla q'cli Inspector: �:5,� (fir , Kti CONSTRUCTION Facility Address: 15-2) w," Well Address: Total Depth: WP# u) " 1! ,LA Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: 1:1 Yes 11 No Drilling Company: (c�Sl Driller Onsite: Screen Length From: To: Consultant: W;111 c. Filter Pack From: To: � Geologist:Geolog ( Bentonite From: To: -C�_� Grout From: To: Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COWPLETION LEnON Method: Ground Sur}ac t +�� Screening Method: grout Verified Chain of Custody: ❑ Yes 0 N �tt' tt. tt. SPOILS Contamination Noted: ❑ Yes ❑No =� If yes, spoils storage Location: slotted soon Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: fL �C� •� Depth to Water: tt- Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation 1)4Boring 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 94 lb allons Bas aallon5 Bags Thickest Thinnest RBags 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com