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SAN JOAQUIN Environmental Health Department COUNTY cyr greatness grows here. C� Monitoring/Well/Soil Boring Inspection Report Date: I / Inspector: V /0` /7 CONSTRUCTION Facility Address: Well Address: -"5 44 1r— j i Total Depth: WP#00 .� L 3 Well#: -3 Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: G Driller Onsite: LL Screen Length From: To: Consultant: 0 r' we f Cor —oFilter 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 ❑No casing If yes, location and distance: WT height SAMPLING ABOVE-GROUND Holding Temperature: COWLEr)ON C40WtEnON Method: G=nd Surf acs Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �ft' ft. tt. SPOILS = Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: stoned on = Covered: ❑ Yes ❑No = 1W If yes, material: GROUTING or DESTRUCTION Total Depth: IF -_ Depth to Water: Grout Material: Pill �1 MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: 9 Gravity ❑Tremie ❑Other: Type of Method: Water Cemen 71b Water Cement 941b allons Ba 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 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 4080 8 � � �S a V J 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.slcehd.com