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SAN JOAQUIN Environmental Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: AI/N Inspector: 9. a CONSTRUCTION Facility Address: 3333 S" l ML.w Well Address: S�IY41c`!Total Depth: WP#w yS qn Well#: Drilling Rig Type: Soil Boring#: V I V 3 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: luevUE T&AI Sewnb Driller Onsite: 4 ,.nn,o4er 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 ❑No casing If yes, location and distance: � height SAMPLING ABOVE-GROUND CONFLErION COMPL COMPLETION Holding Temperature: con4pLErioN Method: Ground Sulac0 + Screening Method: grout Verified Chain of Custody: ❑ Yes ❑Noft• R. SPOILS _ a Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: ' a4cJan ,i, C Covered: ❑ Yes ❑Na If yes, material: = �� GROUTING or DESTRUCTION Total Depth: �5 r IC 1) Depth to Water: V)[ Grout Material: VLCuI ✓vlsl.4 Gallons of Grout Used: 9 Z 4 u I MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size:Boring Installation �oring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout []Over Drill Filter Pack Type/Size: I�Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bags ealions Bees Thickest Thinnest #Bags Thickest Thinnest #Bags _ Bentonite/Cement Mix 3% Mix 5% Mix 2,5 5 1 5 10 1 Bentonite per 47 lb 1 1.41 2.47 s l0 2 10 xo 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 35 70 7 20 40 3 40 BO 8 I& '✓ 5 L4 SCN 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com