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SAN�JOAQUIN � Environmental Health Department —COUNTY— S�c,F�n Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 2.3A3 Ings ector: Stk v 6t( , CONSTRUCTION Facility Address: 915�Z r 0►- ��V f kKv Well Address: Total Depth. �� WP# Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: It?�es []No Drilling Company: e Screen Length From: To: Driller Onsite: Filter Pack From: To: Consultant: �_ Geologist: Bentonite From: To:_d Grout From: To: Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑Yes ❑No casing If yes, location and distance: height SAMPLING AWVE-GROUND COMPLETION GtiRISTY-BOX Holding Temperature: COMPLETION Method: c3coc�na Surf=*`�'_._.. Screening Method: afow Verified Chain of Custody: ❑ Yes ❑No �ft. ft. ft. SPOILS "– Contamination Noted: ❑ Yes ❑No ' = If yes,spoils storage Location: atortod = - as .on Covered: ❑ Yes ❑No If yes, material: GROUTING.or-DESTRUCTION. Total Depth:- IF --- - Depth to Water: Jt. Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: 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 47Ib Water Cement 94 lb allons Bas izallons Bags Thickest Thinnest uBags Thickest Thinnest #Bags BentonitelOement 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 IS 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.socehd.com