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is I* fo�iro c\ SANJOAQUIN Environmental Health Department 4" I —COUNTY Greatness grows here. Monitoring J(Well/Soil Boring Inspection Report Date: Insp ctor: v/mss �1Gi`t CONSTRUCTION Facility Addres : 83 r- 'h, �'S Kltv 4-1 Well Address: Total Depth: WP# 00q 132,9Well#: Drilling Rig Type: Soil Boring#: Drilling Company: rj ] Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Driller Onsite: 176tScreen Length From: To: Consultant: Ot (rGe — UCtO�-fQ� Filter Pack From: To: Geologist: t,Ve- Bentonite From: To: 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: ITT height SAMPLING Agpyg.GRWND CHRISTY_ Holding Temperature: CONFLETION LETioN Method: Ground surfacs Screening Method: grout Verified Chain of Custody: ❑ Yes 1:1 No �ft. ft. it. SPOILS Contamination Noted: ❑ Yes ❑No = r If yes, spoils storage Location: sloned = B sacson41 _ Covered: ❑ Yes El No 96-VW P-NA If yes, material: I r IF GROUTING or DESTRUCTION Total Depth: IF __ Depth to Water: fL n' Grout Material: Cer*^4— Gallons of Grout Used: , ((o 4-5MATERIALS/DEVELOPMENT �� v Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ring 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 gallons Bas gall ons Bags Thickest Thinnest 9Bags Thickest Thinnest 48ags Bentonite/Gement Mix 3%Mix 5%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 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 1 40 80 1 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