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SANsJOAQUIN Environmental Health Department COUNTY- 9kir�aa`" Greotness grows here. Monitoring Well/Soil Boring Inspection Report Date: L9 7 Ins pe_cto . ,✓*� CONSTRUCTION Facility Address: �Jrl ��° Well Address: Total Depth: WP# r2 Z Well#: Drilling Rig Type: Soil Boring#: 1/f I-A Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: ^ /e e* Driller Onsite:(G)�. ?da..� Screen Length From: To: Consultant: YP 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 ❑No casing If yes,location and distance: � height T SAMPLING ABOVE-GROUND r COMPLETION COMPL ON Holding Temperature: COMPLETION Method: GmndSui'°'7 Screening Method: gran Verified Chain of Custody: ❑ Yes ❑ND �n• n. SPOILS k� Contamination Noted: ❑Yes ❑Noy If yes,spoils storage Location: ;' Covered: ❑Yes ❑No soacng-vol Pack If yes, material: c GROUTING or DESTRUCTION Total Depth: 94 Depth to Water:_! n. = n. Grout Material: Al MATERIALS/DEVELOPMENT Gallons of Grout Used: / •J 4L 4!l Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation [Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity Premie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bags eallons Baes _ Thickest Thinnest #Bags Thickest Thinnest 48ags Bentonite/Cement MIX 3%MIX 5%MIX 2.5 5 1 5 10 1 Bentonite per 47 lb 1 1.411 2.47 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 7.5 15 3 15 30 3 - 30 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 209 468-34201 F 209 464-0138 1 www.s'cehd.com