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''°" SA NJ OAQ U I N Environmental Health Department ---COUNTY---- �`9,Foaa¢i Greatness grows here. Monitoring Well/Soil Boring Inspection Report .A, Date: /� Q I Inspector: Vv CONSTRUCTION Facility Address: rC d Well Address: Total Depth: I I WP# 1 ' Well#: Drilling Rig Type: Soil Boring#: Drilling Company: � Min 2" Annular EHD Seal Verified: El Yes []No Driller Onsite: Screen Length From: To: Consultant: Vj C., Filter Pack From: To: Geologist: i S Bentonite From: To: Grout From: To: Public Water System Onsite Domestic Well Onsite: If yes, location and distance: ❑ Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box ❑ Yes ❑ No SAMPLING —E'er Rp t �V1 Holding Temperature: Method: Screening Method: Verified Chain of Custody: SPOILS Contamination Noted: If yes, spoils storage Location: Covered: ❑ Yes ❑ No ❑ Yes ❑No ❑ Yes ❑ No If yes, material: GROUTING or DESTRUCTION Tota Depth: 151 b cj Depth to Water: Grout Material: PJv Gallons of Grout Used: c ❑Well Installation ❑Well Destruction ❑Boring Installation#oring Destruction METHOD USED ❑Pressure Grout ❑Over Drill �ravity ❑Tremie ❑Other: Water allons Cement 47 lb Bas Water gallons Cement 94 lb Bags Thickest Thin t # Thickest Thinnest Jt Bags 2. s 5 1 5 10 1 s 10 20 2 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 630 60 6 17.5 35 7 35 70 7 20 40 8 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 1.41 2.47 Bentonite per 94 Ib 2.82 4.7 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sucehd.com