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SKJOAQUIN Environmental Health Department " "`� —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 5 Inspector: s V=0( CONSTRUCTION Facility Address: Well Address: Total Depth: WP# 26 B S7_ Well#: VIN 4 Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: In�Iwin(f, Screen Length From: To: Driller Onsite: me Consultant: nt`li 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 ❑No casing If yes, location and distance: 111 height SAMPLING ABOVE-GROUND Holding Temperature: COWLETION COMPTMLET1oN Method: Ground Surf act Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No -i--n' tt. SPOILS = = m Contamination Noted: ❑ Yes El No — If yes,spoils storage Location: slotted sacdon Covered: ❑ Yes ❑No If yes, material: '< I C GROUTING or DESTRUCTION Total Depth:_ —_ Depth to Water: Grout Material:N eo m MATERIALS/DEVELOPMENT Gallons of Grout Used: um gt Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction gags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout*ver Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bags gallons Bags Thickest Thinnest 9Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 55% Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 5 10 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 1 25 5 25 5 15s 60 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 i F 209 464-0138 1 www.s*cehd.com