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$A N JOAQUIN Environmental Health Department i COUNTY p ogre' Greatness groans here. Monitoring Well/Soil Boring Inspection Report S Date: y 5 7. Inspector: CONSTRUCTION Facility Add ess: j3 5 E, t4 r��r 5*- 3.7t4*h Well Address: Total Depth: WP# outi O$ Well#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: Screen Length From: To: Consultant: F(-2-C f r,-�yNV Nkron rv&lfcqFilter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING AE&E-GROUND c,�wssrr-aox Holding Temperature: COMi'LEfION COMPLETION Method: oaourd Suriacs �-+ ----- Screening Method: grout Verified Chain of Custody: ElYes ❑No ft. ft. SPOILS � Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: sbn�d iaC'JOr1 %E' -- Covered: ❑ Yes ❑No _ V'w Pack If yes, material: GROUTING or DESTRUCTION Total Depth: ia- Depth to Water: V1 1J ft. Grout Material: ry&V CQO q L I— Gallons of Grout Used: ^' MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation SBoring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity KTremie ❑Other: Type of Method: Water Cement 47lb Water Cement 941b gall Bags gallons Ba s Thickest Thinnest #Bags Thickest Thinnest Bags Bentonite/Cement Miff 3% Mix 5% MIX 2.5 5 1 a P_ 5 10 1 Bentonite per 47 lb 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 lb 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 1 80 8 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