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'- uw\ SAN :JDAQUIN `- Environmental Health Department —COU NTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: d 22' Ins ector:��v`� CONSTRUCTION Facility Address: Well Address: Total Depth: WP# V� Z Well#: Drilling Rig Type: Soil Boring#: _ Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: �'� � y (,� Driller Onsite: Screen Length From: To: � ilter Pack From: To: Consultant: (JCS 917 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 W— T SAMPLING ABOVE-GRCUND • Holding Temperature: COMPLETION o��,��t4 Method: G=nd$tx1'Of + Screening Method: grant Verified Chain of Custody: ❑ Yes ❑No ft•ft- ft_ SPOILS Contamination Noted: ❑ Yes ❑No — Ifyes,spoils storage Location: = o ssc9on Covered: ❑ Yes ❑No = g; V,pac% If yes, material: GROUTING or DESTRUCTION Total Depth: — Depth to Water: 01ie- 6s--00 yti�.P"A 2, "' — ft- GroutMaterial: e' /ie-w T MATERIALS/DEVELOPMENT Gallons of Grout Used: Z ru- boy' ! 9f Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet El Boring Installation ring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: �N4ravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb allons Bas Rallons Bags Thickest Thinnest it Bags Thickest Thinnest *"Bags Bentonite/Cement Mix 3% Mix 5% 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 17.5 35 7 35 70 7 20 40 8 40 8o 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 ( F 209 464-0138 ( www.socehd.com