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SAN. J OAQ U I N Environmental Health Department 1!;i'ai'�• `r —COUNTY— ,, Sac,Foa�;"' Greatness grows here Monitoring Well/Soil Boring Inspection Report Date: 1011 t9 Inspector: NA-S e6-v41 CONSTRUCTION Facility Address: Ly• Well Address: Total Depth: " WP# 00 3Gs73 S Well#: Drilling Rig Type: �i�i��1J� T✓�� Soil Boring#: el Drilling Company: C� G Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Driller Onsite: Screen Length From: To: Consultant: 11ij ejiL (ddek ='..e Filter Pack From: To: Geologist: /l�sw Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: WT height SAMPLING 1180VE.GRCXJND Holding Temperature: COMPLETION COMPLETION Method: c;,rouna sudace Screening Method: o�«n Verified Chain of Custody: ❑ Yes E]No �ft. ft. SPOILS Contamination Noted: ❑ Yes El No If yes, spoils storage Location: a*eton = B Covered: ❑ Yes ❑No _ v.-k If yes, material: GROUTING or DESTRUCTION Total Depth: 1645) _ Depth to Water: 5-5-' ft — n• Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Borin Installation Slot Size: g Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: .Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity kTremie ❑Other: Type of Method: aterent 47 Water Cement 94 lb Bas allons Bags Thickest Thinnest ags Thickest Thinnest ttBags 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 15 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 60 221) 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