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SAKJOAQUIN Environmental Health Department —COUNTY- 44L COUNTY-4Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: ' CONSTRUCTION FacilityA ress: 2,�Cjr � Cant? t� r<� Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: VA 9 S Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes El No Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: e 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: WT height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION CCOMP�LEnoN Method: Ground Sixfwt Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No tt. tt. SPOILS j�. v _ e Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: slotted ` ss�tion Covered: ❑ Yes ❑No _ g,,,W v If yes, material: +' GROUTING or DESTRUCTION Total Depth: 2—o =_ Depth to Water: — tt• tt' Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installationoring 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 ment 471b Water Cement 941b allons Bas allons Bags Thickest Thinnest bBags Thickest Thinnest 48ags Bentonite/Cement Mix jj 3% MIX 5% MIX 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 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 r5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s*cehd.com