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SANIOAQUIN Environmental Health Department COUNTY - c�L`Pi Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: A 6 /� 8 Inspector: W 0(� CONSTRUCTION Facility Address: Zd O iY` S Well Address: i 3 3 S �Lvc Total Depth: WP# 0 0 Well#: Drilling Rig Type: Soil Boring#: Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes []No Driller Onsite: Screen Length From: To: Consultant: Y Filter Pack From: To: Geologist: N'XCC(S.- Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: If yes, location and distance: fAllAM Mir' Holding Temperature:_ Method: Screening Method: Verified Chain of Custody SPOILS Contamination Noted: If yes, spoils storage Location: ❑ Yes ❑No ❑ Yes ❑ No ❑ Yes ❑ No Covered: ❑ Yes ❑ No If yes, material: 0 GROUTING or DESTRUCTION Tot I Depth:�,� .Sc. Depth to Water: .l 0 / 1 J Grout Material: �� c Gallons of Grout Used: ❑Well Installation ❑Well Destruction ❑Boring Installation KBoring Destruction METHOD USED ❑Pressure Grout ❑Over Drill ❑ Gravity �Tremie ❑Other: Water allons Cement 471b Bas Water gallons Cement 941b Bags Thickest Thinnest 1r Bags Thickest Thinnest It Bags 2.5 5 1 5 10 1 5 10 2 10 20 2 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 30 60 6 17.5 35 7 35 70 7 20 40 40 80 8 MATERIALS/DEVELOPMENT Casing Type: Blank Feet Slot Size: Bags of Cement: Bags Sand/Gravel: Type/Brand of Bentonite: _ Filter Pack Type/Size: Type of Method: Screen Feet Bentonite/Cement Mix 3% Mix 5% Mix Bentonite per 47 Ib 1.411 2.47 Bentonite per 94 Ib 2.821 4.7 i 1868 .Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 10/16/2017 www.slcehd.com