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2SAN JOAQUIN Environmental Health Department i' U,114 ` ------COUNT Y Greatness grows here Monitoring Well/Soil Boring Inspection Report Date: I�— Inspector: CONSTRUCTION Facility Address: L 0 u V uO Well Address: to V 0 Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: 0-60. 17is z.) It ��`�, I-)Z� Drilling Company: W V �t� � Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Driller Onsite: (- Screen Length From: To: Consultant: i = Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes 1:1 No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION COMP=ON Method: Ground Stafscs Screening Method: grout Verified Chain of Custody: F-1Yes ❑No �tt' tt. R. SPOILS = _ - m Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: atoned _ - B sao.on Covered: ❑ Yes El No If yes, material: =_ GROUTING or DESTRUCTION Total Depth: Depth to Water: Grout Material: Gallons of Grout Used: ti f ((7 �w{}� MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation/KBoring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb gall s Bas gallons Bags Thickest Thinnest RBags Thickest Thinnest NBags 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 4 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 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