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V II/ 9 O SANJOAQUIN Environmental Health Department —COUNTY— i, sT Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: t 1 ?3 Inspector: iu aiv� ` CONSTRUCTION Facility Address: A 6 Well Address. - Total Depth: WP# U WeIIM, QnLd� Drilling Rig Type: �' Soil Boringlf: Min 2"Annular EHD Seal Verified: ❑Yes ❑No Drilling Company: f G Ct ^ � mJo�" -Lrc �k Screen Length From: To: Driller Onsite: Fv Filter Pack From: To: Consultant: /��L /- 2 5 Bentonite From: To: Geologist: Dt% n Grout From: To: Public Water System Onsite: ❑Yes Wlgo COMPLETION ❑ Stove Pipe []Christie Box Domestic Well Onsite: ❑Yes ZNo casing � If yes,location and distance: height � j SAMPLING AB04&GnCUND CF6itM43Ox Holding Temperature: CON#aLMON COMPLETION Method: groutScreening Method: ft. Verified Chain of Custody: ❑ Yes _-Q-No e. SPOILS Contamination Noted: ❑ Yes ElNo If yes,spoils storage Location: slottad `7 = B aac on Covered: ❑Yes ❑No __ ynva pads If yes, material: I — GROUTING or DESTRUCTION Total Depth: Depth to Water: 0 Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: 'V Z� °> Casing Type: ❑Well Installation ITWell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity PTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b alions Ba s allons Ba s Thickest Thinnest #flags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5%1�47Y 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 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 35 70 7 20 40 1 40 i BO 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