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SAW-JUMIN —COUNTY— Environmental Health Department Greatness grows here. Monitoring Well/Soil Boring Inspection Report i Date: `� `�'� pector: kZj2f, CONSTRUCTION Facility Address: E. Well Address: _ Total Depth: WP 1# 'U,l�q} "'-I Cl Well#: Drilling Rig Type: Drilling Company: Min 2 Annular EHD Seal Verified: ❑ Yes El No Driller Onsite:_ �,��-�ryti�i\. Screen Length From: To: Consultant: Filter Pack From: To: Geologist: V 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: COMPLETION COOArtPLE7iON Method: CkwndSurfaos +----- Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No n• ft. ft. SPOILS Z — Contamination Noted: El Yes ❑No a — If yes, spoils storage Location: stoned _ a sac9on Covered: ❑ Yes ❑No ;w = = gnvt Pck - If yes, material: GROUTING or DESTRUCTION Total Depth. 3 t 3G I 4. Depth to Water: � --V0 n• " — n- Grout Material:N t F� Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation Aell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: Pressure Grout Dover Drill Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94lb allons Bags allons Ba s Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 s 1 5 10 1 Bentonite per 47 lb 1.41 2.47 s Y6 2 10 20 2 Bentonite per 94 lb 2.82 4.7 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 is 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.sjcehd.com