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l SAN ;JOAQUIN Environmental Health Department COUNTY= Greatness grows here. MonitCCoring[�Well/Soil Boring Inspection Report Date: 0M Inspector: iA CONSTRUCTION Facility Address: ' C 61 Well Address: Total Depth: WP# OC2 V Z 2 Well#: Drilling Rig Type: Soil Boring#: — Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: '1`tVYd-00— Driller Onsite: T:f VYG- COM Screen Length From: To: Consultant: '1-,o v(/ti Cit^, 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 El No casing If yes, location and distance: height WT SAMPLING — ASOVE-GROUND c iRarr-eox. Holding Temperature: CO&FLECION COMPLE iON Method: «ind Sutx. Screening Method: grout Verified Chain of Custody: ❑ Yes El No �ft- ft. SPOILS Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: _- slo"d - c Covered: ❑ Yes El No n 3' If yes, material: GROUTING or DESTRUCTION Total Depth: SU —_ Depth to Water: n — 'IFn- Grout Material: C egtA e,,—Gallons of Grout Used: S MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Size: ❑ ,Boring Installationoring Destruction Bags Slot Siziz 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 allons Bas gallons Bags Thickest Thinnest ✓ Bags Thickest I Thinnest sea95 Bentonite/Cement Mix 3% MIX 5% MIX 2.s 5 1 5 1 10 1 Bentonite per 47 Ib 1.41 2.4 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 s 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 B 40 80 8 10/16/2017 1868 E. Hazelton Avenue ( Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com