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c.. ° SAN JOAQUIN Environmental Health Department t� COUNTY Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: \ \\ 2\ Inspectar: `r�5 CONSTRUCTION Facility Address: =>(7()� i �,�t,� LCV I�(k-tC'`'' Well Addres : Total Depth: WP# l.�t..� ( ! 1 k Well#: Drilling Rig Type: Soil Boring#: \ Min 2" Annular EHD Seal Verified: ❑ Yes 11 No Drillirg Company: — �� .��• Screen Length From: To: Driller Onsite: Consultant: Filter Pack From: To: 1L'VV% Bentonite From: To: Geologist: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes No casing If yes, location and distance: WT height SAMPLING AgpyE-GgCUNp Holding Temperature: COMPLETON COMP=CN Method: Gewnd Sumacs Screening Method: grout Verified Chain of Custody: ❑ Yes El No �ft. ft. (t. SPOILS h T Contamination Noted: ❑ Yes ❑No — If yes, spoils storage Location: a*c:cn — 2 Covered: ❑ Yes ❑No = gra vW pack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: i--,L) rJc'kk r ft• ft Grout Material: C'�� rNQ11A. . MATERIALS/DEVELOPMENT Gallons of Grout Used: o 4 Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation�oring Destruction Bags iz 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 gall Bays 9allons Bags Thickest Thinnest 4:Bags Thickest Thinnest 1t 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 -5 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 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com