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SAN JOAQUIN Environmental Health Department C O U N T Y----- Greatness grows here. 9/3 // Monitoring Well/Soil Boring Inspection Report Date: / Inspector: CONSTRUCTION Facility Address: 3 2 0IVC— Well Addres : Total Depth: Wm0 p'000 `7 Well#: Drilling Rig Type: Soil Boring#: CP T l Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Geo —L' X -CSL Driller Onsite: t r- 2 Screen Length From: To: Consultant: Cyt "C . 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 ❑No casing If yes, location and distance: if;ffT height SAMPLING ABOVE-GROUND Holding Temperature: OOWPLETION nON Method: Ground Suiars Screening Method: a•«n Verified Chain of Custody: ❑ Yes ❑No 4Ir ft. it. tt. SPOILS k Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: slatted section _ Covered: ❑ Yes ❑No = Grave+va-k If yes, material: GROUTING or DESTRUCTION Total Depth: 5C� Ff �X `J t. Depth to Water: n' Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: O►`�i Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity txTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b saara Ilons Bas eall ons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3%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 40 80 8 2 0/f4 5 b a�S 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