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SAN JOAQUIN Environmental Health Department L--�(': _ —COU NTY-- 4k,os Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: Facility Address: CONSTRUCTION Well Address: n \ s 9, U _�1 "", Total Depth: Cement 471b Bas WP# g Lk -1,-k 1q Well#: Drilling Rig Type: Cement t9i Bags Soil Boring#: 9Bags Thickest Thinnest Drilling Company: �y„�L� � �n�� a� f�` ��— Min 2" Annular EHD Seal Verified Driller Onsite: Screen Length From: Consultant: Filter Pack From: Geologist: Bentonite From: 2 Grout From: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe Domestic Well Onsite: ❑ Yes ❑No If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method:_ Verified Chain of Custody: ❑ Yes El No conn c Contamination Noted: ❑ Yes ❑ No If yes, spoils storage Location: Covered: ❑ Yes ❑ No If yes, material: GROUTING or DESTRUCTION Total Depth: JCo , Depth to Water: Grout Material: N �A Gallons of Grout Used: 111Well Installation ❑Well Destruction ❑Boring Installation ❑Boring Destruction METHOD USED ❑Pressure Grout ❑Over Drill ❑ Gravity VTremie ❑Other: Vv 4 Water allons Cement 471b Bas water gallons Cement t9i Bags Thickest Thinnest 9Bags Thickest Thinnest "Bags 2.5 5 1 5 10 1 5 10 2 10 20 2 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 ❑ Yes ❑No To: To: To: To: ❑Christie Box casing height ri —WW—f ABOVE -GROUND CHRISTY43OX 0OWLEr10N comPLfiT10N Ground surtx. Grout tt. tt. tt. _ o slotted = Z Becton Gravel aaac tt. I F=I Ftt. MATERIALS/DEVELOPMENT Casing Type: Blank Feet Slot Size: Bags of Cement: Bags Sand/Gravel: Type/Brand of Bentonite: _ Filter Pack Type/Size: Type of Method: Screen Feet Bentonite/Cement Mix 3% Mix 5% Mix Bentonite per 47 Ib 1.41 2.47 Bentonite per 94 Ib 2.82 4.7 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