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SAN JOAQUIN COUNTY Environmental Health Department Greatness grows here 2 Y/� Monitoring Well/Soil Boring Inspection Report Date: U I"I Inspe or: �� CONSTRUCTION LGC'f1'005UC; W Facility Address. re( M&—'V'V Well Address: Total Depth: WP# 00 ?;Cl 4 9 Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: bcaz Screen Length From: To: Consultant: yya ( ')fy► -lawn",) Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To:— Pub]ic o:Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: WT height SAMPLING AWVE-GROUND Holding Temperature: COA'�I.ETION CCoMPPLEnooN Method: Gmnd Sudan Screening Method: grow Verified Chain of Custody: ❑ Yes El No �ft. n. tt. SPOILS vA= O Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: slatted on — B Covered: ❑ Yes ❑No = g-vw Pack If a material: x GROUT I or DESTRUCTION Total Depth: = _ Depth to Water: n• " — n Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest aBags Thickest Thinnest Ai Bags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 s 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 T + ��11bS) � SAW �3c�� IJW1 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 TT 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com