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SAN J O A Q U I N Environmental Health Department ---COUNTY Monitoring Well/Soil Boring Inspection Report Date: I Z �-1 Inspector:(TIca-e L( CONSTRUCTION Fa ci I ity Ad d ress: '�oJ [4uwh>-„L-,, Well Address: Total Depth: WP# 4�-)- ty Well#: Drilling Rig Type: Soil Boring#: 1r "-L ' Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: r Driller Onsite: Screen Length From: To: Consultant: ( Filter Pack From: To: Geologist: SA44� 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: height iii SAMPLING A.8ovE-GRCUND Holding Temperature: CONFLF-TCN cccmptEnoN Method: G=nd Surface Screening Method: grout Verified Chain of Custody: ❑ Yes El No �ft. ft. ft. SPOILS V Contamination Noted: ❑ Yes ❑No = If yes,spoils storage Location: afonad sac.on _ Covered: ❑ Yes ❑No If yes, material: _ GROUTING or DESTRUCTION Total Depth: Depth to Water: Grout Material: t,I �- ('v>� �` � MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation-y'oring 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 allons Bas wallons Bags Thickest Thinnest ✓1Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 3% 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 17.3 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com