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SAN,JOAQUIN Environmental Health Department —COUNTY— ":= Greotness Grow- here. Monitoring Well/Soil Boring Inspection Report Date: toln-11A Inspector: L-V CONSTRUCTION Fa ci I ity Ad d ress: 2SIZ5 S Abk Well Address: Total Depth: WP#DOSfrslo� Well#: Drilling Rig Type: (�n��go Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: n n Screen Length From: To: Driller Onsite: `�,cr 0 Filter Pack From: To: Consultant: &Cc"40, Bentonite From: To: Geologist: &1'h 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: refight SAMPLING JlWV=E-jbR0U?]D _ Holding Temperature: coFON OOMPLETION Method: GmUrA Sulx' Screening Method: Orovc Verified Chain of Custody: ❑ Yes ❑No 's rz. tt. SPOILS 'g- a Contamination Noted: ElYes ❑No — If yes, spoils storage Location: zr = o Covered: ❑ Yes ❑No If yes, material: - GROUTING or DESTRUCTION Total Depth: —70 _ Depth to Water: - F tt" Grout Material: f1t.�fi Gallons of Grout Used: — 160ti MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Borin Installation Slot Size: g oring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity CQT<mie ❑Other: Type of Method: Water cement 471b Water Cement.94 lb gallons Bas Rallons Bags Thickest Thinnest 4Bags 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 30 310 20 A 20 40 4 k q / i 12.5 25 5 25 50 5 �'�jS 15 30 30 0 17.5 35 7 7 35 7 7 70 7 J" 20 40 8 40 1 80 8 4011 ow 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slcehd.com