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SAN JOAQUh, Environmental Health Department —COUNTY— Greatness grows here. �77 Q Monitoring Well/Soil Boring Inspection Report Date:T �o / q Inspector: "v CONSTRUCTION Facility Address: L30 11` �uS �CI Well Address: inn Total Depth: WP# 3 r9 Z Well#: Drilling Rig Tipe:�/_Y iR/l� Soil Boring#: 5 Drilling Company: ' 7 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Driller Onsite: L o r Screen Length From: To: Consultant: Id rtG Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑Yes ❑No' COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ONO Y casing If yes,location and distance: height � _CWT SAMPLING ABOVE-GROUND CHFIM r-eox Holding Temperature: OOMPLEr1oN cOMP1ETION Method: Ground Svlecs T� Screening Method: cr«n Verified Chain of Custody: ❑ Yes ❑Non• _n. n. SPOILS Contamination Noted: ❑Yes ❑No If yes,spoils storage Location: ' slotted 3 = soc#on Covered: El ❑No _ gravel peck If yes, material: GROUTING or DESTRUCTION Total De the Depth to Water: 2( r n• �n Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation Boring Destruction Slot Size: v l Bags of 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 Ilons Bags mallons Ba s Thickest Thinnest it Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix_ 2.5 5 1 5 10 1 JE3entonite per 47 lb 1.41 2.47 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 7.5 35 3 15 30 3 30 20 4 20 40 4 12.5 25 5 25 50 5 is 30 6 30 60 6 17.5 35 7 35 70 7 20 40 # 40 80 a 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