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SAN JOAQUIN COUNTY— Environmental Health Department Greotness gro;,s tom/ Monitoring( �Well/Soil Boring Inspection Report Date: x/21' Ins ector: `')l/� >1"/if CONSTRUCTION Facility Address:__J3l3 vk/ I c 1 a C Well Addres (3 LS Q Z�_TV G Total Depth: WP# 00 L S91 Well#: Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: MO- oiler 1b5. Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: 0 Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: WT height SAMPLING ABOVE-GFICUND _ Holding Temperature: � 1ON cCC+APtEioN Method: Ground surf"' Screening Method: erg Verified Chain of Custody: ❑ Yes El No �ft- ft. ft. SPOILS u Contamination Noted: ❑ Yes El No = If yes,spoils storage Location: • abttvd �: � c sacaon Covered: ❑ Yes El No If yes, material: GROUTING or DESTRUCTION Total Depth: ca Depth to Water: fL Itt. Grout Material: y•3 ffc'clt C�he"V Gallons of Grout Used: t"Y" ( l U Yds , L+ b`Jc�S MATERIALS/DEVELOPMENT Casing Type: ell Installation ❑Well Destruction ':S jGLS :Blank Feet Screen Feet ❑Boring Installation ❑ Slot Size: Boring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity remie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas pallons Bags Thickest Thinnest ;:Bags Thickest Thinnest .1 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 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 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