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SAN JOAQUIN Environmental Health Department COUNTY— Greatness OUNTY—Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: �\ Inspector: CONSTRUCTION Facility Address: Well Address: _an Total Depth: _ WP# 1'C\Z140 Well#: Drilling Rig Type: (�AU`�) yjs:lc". Soil Boring#: Min 2"Annular EHD Seal Verified: Yes ❑No Drilling Company: �Qt�1�iQ(� - �,0�5 Screen Length From: To: Driller Onsite: 'S��1J Consultant: Filter Pack From:Ip0 To: N®4' F it t enone From: Geologist: B � 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:N,*:) p 404 height "4-Q SAMPLING AWVE-GROUND Holding Temperature: cohePLErION cav+P rior�i Method: G=ndsw°" ' Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No ft- ft. ft. SPOILS — Contamination Noted: ❑ Yes ❑NoAr =` If yes,spoils storage Location: stottad � — .E Covered: ❑ Yes ❑No If yes, material: �r GROUTING or DESTRUCTION Total Depth: \00 V_ r Depth to Water: ft. ft' Grout Material: `ti�'�lkp-d2A' MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ?\}(, ' ]Well Installation ❑Well Destruction Blank Feet Screen Feet VV\\ Slot Size: ❑Boring Installation []Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: 5Alj. - � 2�•� �C , ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity IMTremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb allons Bas gaill ons Bags Thickest Thinnest ttBags Thickest Thinnest ttBags Bentonite/Cement MIX 3% MIX 5%Mix 2.5 s 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 12.5 25 5 25 50 515 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 IN 5 -L - 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.smcehd.com