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SAN J OAA U I N Environmental Health Department COUNTY— Monitoring Well/Soil Boring Inspection Report Date: L Inspector: �OL,- t�sD CONSTRUCTION Facility Address: ' ��1) V� f�9��G Ingmte(4 Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: T� Min 2"Annular EHD Seal Verified: El Yes ❑No Drilling Company:�,� Screen Length From: To: Driller Onsite:- 1A) i 11 Consultant: Filter Pack From: To: Geologist: 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: ` height SAMPLING ABOVE-GROUND Holding Temperature: COWLETJON COOMiPI F'I,oN Method: Grwnd Swfacs Screening Method: gr_.-t vll� 10/1 Verified Chain of Custody: ❑ Yes El No - ----ft• SPOILS — a Contamination Noted: ❑ Yes El No = m If yes,spoils storage Location: stance Covered: ❑ Yes ❑No - vnv+Pack If yes, material: GROUTING or DESTRUCTION Total Depth: I Fr -E : Depth to Water: ——tt• — n Grout Material: ky . MATERIALS/DEVELOPMENT Gallons of Grout Used:_ Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation Boring Destruction Bags Size: Cement: METHOD USED QTYI; GN0 1 Bags Sand/Gravel: �_ Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity E(Tremie ❑Other: Type of Method: Water Cement 471h water Cement 941b allons Bas gallons Bags Thickest Thinnest 4Bags Thickest Thinnest 4Bags 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 is 25 5 25 50 5 C1 O ' 1YM -441 A/ 15 30 6 30 60 6 ((,j�,i�,i{�1 ¢¢��^ 17.5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com