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j SANJOAQUIN Environmental Health Department !J COU NTY--- cQu � Greotness grows here. Monitoring Well/Soil Boring Inspection Report Date: In ector: +2� CONSTRUCTION Facility Addres : Y I Well Address: i, I �n . Total Depth: WP#� N.a Ili Well#: Drilling Rig Type: Soil Boring#: Drilling Company: I Min 2 Annular EHD Seal Verified: ❑ Yes 11 No Driller Onsite: Screen Length From: To: Consultant: 7 � l Filter Pack From: To: Geologist: J11TBentonite From: To: 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: WT height SAMPLING ABOVE-GROUND Holding Temperature: CO+"FLETION COMPLPnoN Method: Ground Surface Screening Method: ofO1t Verified Chain of Custody: ❑ Yes El No R. R. SPOILS v: v= a Contamination Noted: ❑ Yes El No �- If yes, spoils storage Location: •bid an Covered: ❑ Yes El No = Q,,,'W If yes, material: EE GROUTING or DESTRUCTION Total Depth: Depth to Water: n• In tt. Grout Material: • h/�Yl�- Gallons of Grout Used: y� MATERIALS/DEVELOPMENT 1 Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation 1Boring Destruction 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 941b g.all Bas eallons Bags Thickest Thinnest uBags Thickest Thinnest nBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 2 10 20 2 u1. Bentonite per 94 Ib 2.82 4.7 7.5 is 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 s0 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.socehd.com