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S A N J O A Q U I N Environmental Health Department COUNTY f'y10%`-''' Greatness grows hers.. Monitoring Well/Soil Boring Inspection Report Date: �j �2,�1 Z`� Inspector: 9" CONSTRUCTION Facility Address: wo V1064t, witscm c_.y Well Address: J Total Depth: WP#0044 S 27.1 Well#: Drilling Rig Type: Soil Boring#: Z Min 2" Annular EHD Seal Verified: ❑ Yes []No Drilling Company: 1 lc*1rS Driller Onsite: Screen Length From: To: �_�� Filter Pack From: To: Consultant: L41 Geologist: • �1�(50o IG, aV1L4CcAL, 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 RX,I' SAMPLING A80VE-GROUND Holding Temperature: GOMPLETnN COMP=CN Method: Ground Surixs Screening Method: arm Verified Chain of Custody: ❑ Yes El No i ft. ft. ft. SPOILS = — a Contamination Noted: ❑ Yes El No 0 If yes, spoils storage Location: slotted ._ aeon _ Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: Ste_ Depth to Water: 04 ft. LL. Grout Material: _ yl5�C'e&*g L_t.44_ Gallons of Grout Used: MATERIALS/DEVELOPM ENT � �u� Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: [j�Gravity ❑Tremie ❑Other: Type of Method: bl+ater Cement 471b Water Cernent 941b allons Bags Qallons Bags Thickest Thinnest #Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% MIX 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 1 .41 2.47 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 7.5 15 3 15 30 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 Stockton, California 95205 ( T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com