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SA N J OAQ U I N —COUNTY— Environmental Health Department " ! `r Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: li 2G Inspector: `� CONSTRUCTION Facility A!d d r6 ss: 716GbO QL, rat, Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Drilling Company: 5 r� Min 2"Annular EHD Seal Verified: El Yes ❑No Driller Onsite: Screen Length From: To: Consultant: C Filter Pack From: To: Geologist: "�aW pec A 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 ABOVEGROUND Holding Temperature: COWLETION COMPL 71oN Method: around Surfac* Screening Method: grout Verified Chain of Custody: ❑ Yes El No ft. tt. SPOILS _ - e Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: sbned _ s aacson — � Covered: ❑ Yes ❑Nogravol= i ack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: 10��- n Grout Material: DhA aa!k' 1-L Gallons of Grout Used: Zj MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction t5 X\ d� Blank Feet Screen Feet Y• Slot Size: ❑Boring Installation RlBoring Destruction 25 �\ Bags of Cement: METHOD USED tyouk. 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 IBags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 5 1 5 10 r r.) Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 2 0 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 7 35 70 7 20 40 8 40 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.sacehd.com