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41" %v SAN-dOAQUIN Environmental Health Department �` Kf COUNTY— �i Gareotpess grows here. Monitoring Well/Soil Boring Inspection Report Date: 7//4 Inspector: om &< CONSTRUCTION Facility Address:22 911 5,,A tud t, K.oeh Qd Well Address: 'i Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: El Yes ❑No Drilling Compan: Jell _Ptb"#%*% Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: �,,;1 Bentonite From: To: Grout From: To: Public Water System Onsite: ❑Yes ❑No COMPLETION O Stove Pipe ❑Christie Box Domestic Well Onsite: ❑Yes ❑No casing If yes, location and distance: fi heigtrt SAMPLING J1SOYE-Gf30tJND Holding Temperature: co&FLET1oN ccmmi fox Method: ' s } Screening Method: Orart Verified Chain of Custody: ❑Yes ❑NoIt- ft. SPOILS Contamination Noted: ❑Yes ❑No = ?" if yes,spoils storage Location: Covered: ❑Yes ❑No If yes,material: _ Pack o GROUTING or DESTRUCTION Total Depth: 50 1} Depth to Water:_ �3t - tt- Grout Material: "'A e.t •+»�� MATERIALS/DEVELOPMENT Gallons of Grout Used: O.,�tWVA3 Casing Type: ❑Well Installation 1]Well•Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation XBoring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ElPressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity XTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b Ilons Bags Rallons Bags Thickest Thinnest #Bags Thickest Thinnest #Baas Bentonite/Cement Mix 3%Mix S%Mix 2.5 5 1 5 10 1 1 Bentonite per 47 lb 1.41 2.47 s 10 2 10 20 2 1 Bentonite per 94 Ib 2.52 4.7 7.5 15 3 15 30 3 y 10 20 4' 20 40 q 12.5 25 5 25 50 5 1 25 15 30 6 30 60. 6 J / 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 IF 209 4646138 1 wvinv.sicehd.com