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SAN JOAQUIN Environmental Health Department COUNTY- Greatness OUNTY—Greatness grows herc Monitoring Well/Soil Boring Inspection Report Date: `r/'� inspector: /vT of CONSTRUCTION Facility Address:TOe �` i eq" Well Address: Total Depth: WP# 60 yL yOS/ Well#: Drilling Rig Type: Soil Boring#: 1 Z Min 2"Annular EHD Seal Verified: ❑ Yes [I No Drilling Company: /j'1i /e aww Screen Length From: To: Driller Onsite: Wse Filter Pack From: To: Consultant: /!^ Bentonite From: To: Geologist: Grout From: To: Public Water System Onsite: ❑ Yes 0 N COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: IT�T height SAMPLING ABOVE-GROUND Holding Temperature: CO�`'F�ION cLEnoN Method: Ground Surface Screening Method: gran Verified Chain of Custody: ❑ Yes ❑No —`---n' n. n. SPOILS y Contamination Noted: ❑ Yes El No = If yes, spoils storage Location: sbitaC K- — sacson = Covered: ❑ Yes ❑No = gr.;W p..k If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: n. Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation g Slot Size: Corin Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity 56remie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Basallons Ba s Thickest Thinnest 9Bags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 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 10 20 4 20 40 4U' 12.5 25 5 25 50 5 15 1 30 6 30 60 6 evP%� ! .✓� �"'� c 17.5 35 7 35 70 7 P�� Qdol 20 40 8 40 80 8 vd t� 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.s*cehd.com