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I/�r'- J�, SAN5J0AQUIN �� .� . Environmental Health Department 'ri;.:.:: —COUNTY �.= Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: \ 1 201% Inspector: CONSTRUCTION Facility Address: Well Address: Total Depth: WP# Well#:fV,LJ 9b Drilling Rig Type: Soil Boring#: �� r Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company `-`{- �T _ Screen Length From: To: Driller Onsite: - Filter Pack From: To: Consultant: �,%u Geologist: L-". Bentonite From: To: Grout From: To: Public Water System Onsite: /Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domesl� Well On e 83 ❑ Yes ;dNo casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: m&FLIZION coMPLEricN Method: Ground Safaco" + Screening Method: prom Verified Chain of Custody: ❑ Yes ❑No 4r fi. ft. SPOILS Contamination Noted: ❑ Yes ZN o _ If yes, spoils storage Location: soon " Covered: Yes ❑No s-1w tack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: —tt. x' Grout Material: t-1 Gallons of Grout Used w �Z5 d MATERIALS/DEVELOPMENT �c Casing Type: ❑Well Installation /Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED 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 Rallons Bags Thickest Thinnest #Bags 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 lb 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 35 70 7 20 4 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.s'cehd.com