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:. ; SANJOAQUIN Environmental Health Department ` —COUNTY Greuhiess grows here. Monitoring Well/Soil Boring Inspection Report Date: 2 Inspector: 4 I i, rCONSTRUCTION Facility Address: \1)10 �- W i kSO tN �J �v Well Address: �J � Total Depth: WP# C&A 4()0Q Well#: �/ Drilling Rig Type: Soil Borin #:_,jAM%G , C)5q , S53 , �2 I Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: C",;j Driller Onsite: Screen Length From: To: Consultant: Cb,1("t liY1F,1I L° W Filter Pack From: To: Geologist: Bentonite From: To: SD�� wM 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 ABOVEGROUND Holding Temperature: COMPLETION coat iTtoN Method: Grosind Surface Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No ft• ft. ft. _ SPOILS Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: slonad sacdon g Covered: ❑ Yes ❑No N If yes, material: ---GROUTING-or-DESTRUCTION Total-Depth: =T Depth to Water: No C=urj W&fgr n• tt• Grout Material: +- MATERIALS/DEVELOPMENT Gallons of Grout Used: V d Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation ❑Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Bran-d of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cem t 471b Water Cement 94lb gallons Bags gallons Bags Thickest Thinnest i1lgs Thickest Thinnest #Bags Bentonite/Cement Mix 3% ♦!V1ix 5%Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 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 7 3S 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