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SANJOAQUIN Environmental Health Department COUNTY----- ,'`9u Greatness grows here •'55 1r0 -l.VoayvN Monitoring Well/Soil Boring Inspection Report 3.0-'�5 It Date: Inspector: CONSTRUCTION Facility Address: Well Address:— Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Z! Drilling Company: �f<j.� Min 2"Annular EHD Seal Verified: E-1 Yes ❑No Driller Onsite: 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 ❑No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: OONFLETION C00APtEnON Method: Ground Surface + Screening Method: grout Verified Chain of Custody: ❑ Yes El No -�--n' s. ft. SPOILS = Contamination Noted: ❑ Yes QNo =` If yes, spoils storage Location: abn�d sacJon Covered: ® Yes 1:1 No v = grays+Pack If yes, material: K6u\ bay t 5 - GROUTING or DESTRUCTION Total Depth: Depth to Water: Grout Material: WaLt Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet 9- ❑Boring Installation Boring Destruction 2�tj�, Slot Size: !/ Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill ' Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity /51.Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 3%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 2 Bentonfte per 94 Ib 2.82 4.7 7.5 15 3 t/ 15 30 3 10 20 20 40 4 12.5 25 5 25 so 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.secehd.com