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SAN JOAOUIN Environmental Health Department ---COUNTY-- Greatness grows here. 1 �n Monitoring Well/Soil Boring Inspection Report Date: SII pW 18 In_specr: A40 CONSTRUCTION Facility Address: 4 4-r-r Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: ,e a F-I - Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: � Screen Length From: To: Consultant: Cto Filter Pack From: To: Geologist: O ;r� 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: W height SAMPLING Agpyg.tgpUNp Holding Temperature: COMPLETION CCOOMPLETION Method: G=nd Sur(act'+'�� Screening Method: a�«n Verified Chain of Custody: ❑ Yes El No it. n. SPOILS Contamination Noted: ❑ Yes ❑No = If yes, spoils storage Location: sbned ' asedan _ $ Covered: ❑ Yes ❑No _ l-w+pack If yes, material: '= GROUTING or DESTRUCTION Total Depth: __ Depth to Water: C �' I n- n' Grout Material: &e&i' cpmR44 Gallons of Grout Used: ff 3 U o•' ">t' S2 pa `J5)4 MATERIALS/DEVELOPMENT — I Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation XBoring Destruction 2 �1 Bags Size: Cement: METHOD USED �'V'� r-,-4-� J r� J �5 Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity '%Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas eallons Bags 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 10 2 10 20 2 Bentonite per 94 Ib 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 8 40 80 8 -�t 90. 10/16/2017 a4 �.4 S,5 b 9S 1868 Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.socehd.com