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SAN J OA Q U I N Environmental Health Department —COUNTY— Greatness grows here / Monitoring Well/Soil Boring Inspection Report Date: 0 1At Inspec or: Sc�S' CONSTRUCTION Facility Address: foul 2 ''ja '�� Well Address: Total Depth: WP# l7'T 7 1 qr�- Well#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: El Yes El No Drilling Company: C Rn.. e4i fo--,3 -Z,)Lc, Screen Length From: To: Driller Onsite: "(Loy+✓ Filter Pack From: To: Consultant: Geologist: 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 SAMPLING ABOVE-GROUND Holding Temperature: COMPIEMN CCOOM LON Method: Gnxmd Surface ' Screening Method: grttrt Verified Chain of Custody: ❑ Yes El No ft. tt. SPOILS = Contamination Noted: ❑ Yes []No = If yes, spoils storage Location: sbttad sac'cn _ Covered: ❑ Yes ❑No — -4 Pack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: n tt' Grout Material to ,3 50,^--k Cerie-*.-,i- Gallons of Grout Used: ^- )'�� , MATERIALS/DEVELOPMENT Casing Type: *ell Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring 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 94 lb ailons Bas gallons Bags Thickest Thinnest ttBags Thickest Thinnest xBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 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 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.sacehd.com