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>'° = SAN JOAQUIN Environmental Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: / � ) Inspector: �.1� CONSTRUCTION i Facility Address- �Ph /� lq I Well Address.. �� Total Depth: �O U WP# 00 if �� Wells+ Drilling Rig Type: Soil Boring#: .v"-� (j Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: 4 b Screen Length From: To: Driller Onsite: Filter Pack From: To: Consultant: Bentonite From: To: Geologist: I Grout From: To: Public Water System Onsite: ❑Yes El No COMPLETION ❑ Stove Pipe []Christie Box Domestic Well Onsite: ❑ Yes ❑No casing height If yes, location and distance: jFa .' SAMPLING ABOVE-GROUND GtiR15rY 80X COWPLETION COMPLETION Holding Temperature: GrotindSurfacs __:....._ Method: «. proof Screening Method: ft. Verified Chain of Custody: ❑ Yes ❑No tt. ft. _ SPOILS �y�, J_�6cjG'+ Fes -= • Contamination Noted: ❑No _ If yes, spoils storage Location: stoned sacfon Covered: ❑Yes ❑No = qa wP� If yes, material: GROUTING or DESTRUCTION Total Depth: —= n. Depth to Water: 7 I 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 A S v H C n Bags Sand/Gravel: w(\A,l "N'L S Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill ►M G W Filter Pack Type/Size: G avity Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Ba s gallons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3%Mix 5% MIX 2 5 5 1 s l0 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 io 20 2 Bentonite per 941b 2.82 4.7 7.5 15 3 =80 10 20 4 12.5 15 3 i 6 17.5 35 7 20 40 8-4�o 10/16/2017 ��, LA b Lis ? <i�k�r ( c U�� 1b 1"�s/J 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 'F'�09 464-0138 1 www.secehd.com