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SAN J OAQ U I N Environmental Health Department COUNTY Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: CONSTRUCTION Facility Address: L Well Address: Total Depth: / (9 C) WP# 0 0 q0rWell#: Drilling Rig Type: Soil Boring#: T Q 2 Min 2" Annular EHD Seal Verified: ❑ Yes El No Drilling Company: `as Driller Onsite: /'�,, r :c—�—,an� Screen Length From: To: Consultant: 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 El No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION ION COON SON Method: G=r)d Surface Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No h• ft. ft. SPOILS — Contamination Noted: ❑ Yes El No If yes, spoils storage Location: atoned on — Covered: ❑ Yes ❑NoV'Pack If yes, material: GROUTING or DESTRUCTION Ttal Depth:_ Depth to Water: ftft• Grout Material: -, vy, Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation Loring Destruction Slot Size: 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 Cement 471b water Cement 941b allons Bas gallons Bags Thickest Thinnest #Bags Thickest Thinnest 9Bags Bentonite/Gement 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 35 70 7 20 40 1 8 40 80 8 !n a '51p Lc' (A 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