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SAN JOAQUIN Environmental Health Department " Wr —COUNTY--- � ekP� Greatness grows here. iq Monitoring Well/Soil Boring Inspection Report Date: -712L41 I I1 Inspector: CONSTRUCTION Cot-No�±G WjL dd Facility Aress: I bt5C hfM4 0- Well Address: j Total Depth: WP#n�)3g4I34 Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: El Yes ❑No Drilling Company; �1lrfm Screen Length From: To: Driller Onsite: Consultant: E eWI C_ .1.._ct Filter Pack From: To: 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: height SAMPLING ABOVE-GROUND Holding Temperature: COWPLEr1ON comPLFnoN Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes El No �ft' it. ft. SPOILS Contamination Noted: ❑ Yes El No =" _ If yes, spoils storage Location: slotted K! _ ascon Covered: ❑ Yes ❑No gravell Pack If yes, material: GROUTING or DESTRUCTION Total Depth: _= Depth to Water: Grout Material: NevtMATERIALS/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: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water ement 471la Water Cement 941b gallons Bas gallons Bags Thickest Thinnest NBags 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 10 204 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 N 2-19Cd4'W+ GI bryoa 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.socehd.com