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r`or-6-- � ¢ SANJOAQUIN Environmental Health Department If t�)' -—COUNTY Gieotness grows here. Monitoring Well/Soil Boring Inspection Report Date: )MVID& Inspector: '�tlilncoCONSTRUCTION Facility A dress: SZZ Z t2•SAclt iee MS10C,401 Well Address _ Total Depth: WP# eY�`'1� Well#: Drilling Rig Type: Soil Boring#: p �uV }I Min 2"Annular EHD Seal Verified: El Yes El No DrillingCompany: til t y Driller Onsite: Screen Length From: To: Consultant: 15*o.V"1 6� leo SJVUie. Filter Pack From: To: ' Bentonite From: To: m Geologist:_ att -s 50Y',i1F.V Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: 3M height SAMPLING ABOVE-GROUND HoldingtPn iTemperature: COWPLErrON CO1FON Method: Ground Surface Screening Method: aofO11t Verified Chain of Custody: ❑ Yes El No tt. n. SPOILS . _- Contamination Noted: ❑ Yes El No If yes, spoils storage Location: slotted _ 8 soon — Covered: ❑ Yes El No = i-vl+Pack If yes, material: GROUTING or DESTRUCTION Total Depth: � - Depth to Water: (N0A'9V Grout Material: Gallons of Grout Used: �� MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation —Nell Destruction Blank Feet Screen Feet Slot Size: ❑Boring InstallationgBoring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity -IV—Tremie ❑Other: Type of Method: Water Cement 47lb Water Cement 941b allons Bas gallons Bags Thickest Thinnest ABags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 51 (y 5 16 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 16 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 1 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