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SAN JOAQUIN Environmental Health Department —COUNTY Greotness grows here. Monitoring Well/Soil Boring Inspection Report �7 Date: Zy Inspector: lr1Qs CONSTRUCTION Facility Ad ess. yll Well Address: Total Depth: WP#� Well#: Drilling Rig Type: Soil Boring#: htn Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Cb r ktuppqt Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: " Bentonite From: To: Grout From: To: Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ONO casing If yes,location and distance: .4- height SAMPLING ABOVEGROUND COWPLE ION CLETIO Holding Temperature: cofOMP.+PlELioN Method: Ground S"rtac• Screening Method: gran Verified Chain of Custody: ❑ Yes ❑No �ft. ft. SPOILS v — a Contamination Noted: ❑ Yes ❑No ;? _ If yes,spoils storage Location: socdon = 8 Covered: ❑ Yes ❑No — gravel Pack If yes, material: GROUTING or DESTRUCTION Total Depth:�� Depth to Water: h• — # Grout Material: _ h MATERIALS DEVELOPMENT Gallons of Grout Used: �1� Casing Type: []Well Installation ]Well Destruction Blank Feet Screen Feet ❑Boring Installation ❑Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity ySremie ❑Other: Type of Method: Water _Yce ent471 Water Cement 941b allons Ba s alions, Bags _ Thickest Thinnest ags Thickest Thinnest 4Bags _ Bentonite/Cement Mix 3% Mix 5%MIX 2.5 5 t 5 10 1 1 Bentonite per 47 Ib 1.41 2.47 5 wo 2 10 20 2 Bentonite per 94 lb 2.82 4.7 7.5 15 3 15 30 3 to 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.socehd.com ''yf n a,r--6lC • "+