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SANJOAQUIN Environmental Health Department COUNTY- Monitoring Well/Soil Boring Inspection Report Date:g 2 Inspector: i CONSTRUCTION Facility dress: Y�l( � Well Address: Total Depth: WP# (')C)'4Well#: Drilling Rig Type: Soil Boring#: kE, Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: f l Driller Onsite: Screen Length From: To: Consultant: 1_�t>1 Filter Pack From: To: Geologist:�Q, (� Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box Domestic Well Onsite: ❑ Yes [I No casing If yes, location and distance: height 17 SAMPLING ABOVE-GROUND Holding Temperature: COWLET1ON ccootit�orXi Method: Ground Swfacs Screening Method: Oran Verified Chain of Custody: ❑ Yes ❑No —n' n. tt. SPOILS =_ m Contamination Noted: ❑ Yes El No = If yes, spoils storage Location: abed &*c2on — Covered: ❑ Yes ❑No = „ ?i = If yes, material: r — GROUTING or DESTRUCTION Total Depth: �•5 _- Depth to Water: Grout Material: Gallons of Grout Used: ^' MATERIALS/DEVELOPMENT /�� MO�j Casing Type: ❑Well Installation ❑Well Destruction ` , �r Blank Feet Screen Feet Slot Size: El Boring Installation f5�Boring Destruction <� e .` 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 allons Bas gallons Bags Thickest Thinnest +r Bags Thickest Thinnest "Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 r 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 v 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 a 40 80 s 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