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`r SAN.JUAQUIN Environmental Health Department —COUNTY— _ Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: ti Inspector: CONSTRUCTION Facility Address: 1 b`L Ej!� -'�+t'r ti� V� � � 3. Well Address: Total Depth: WP#_ W8 •-LS U bL Well#: Drilling Rig Type: Soil Boring#: S�1 E ) - 3 Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company:� �� Lam , Driller Onsite: Screen Length From: To: Consultant: ln.�o �.nN «L Filter Pack From: To: Geologist: "Cl) A Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height SAMPLING r._ 9TF Holding Temperature: CONFLEr10N COMPLETION Method: G'rxJ Suriwe Screening Method: grout Verified Chain of Custody: ❑ Yes El No Ill, —ft. tt. ft. SPOILS " K — Contamination Noted: ❑ Yes ❑No a' _ If yes, spoils storage Location: slotted �a sac5on — Covered: ❑ Yes ❑No _ > ack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: `�^ 25 —T— ft• '" — Lj IFft- Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation Boring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout Over Drill Filter Pack Type/Size: ❑ Gravity dTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gallons Bags Rallons Ba s Thickest Thinnest #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 5 0 2 10 20 2 Bentonite per 94 lb 2.82 4.7 7.5 15 30 3 10 4 20 40 4 12.5 -26, 25 50 5 15 30 60 6 17.5 35 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.sic_ehd.com