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1pP°6'"cz, SAKJOAQUIN O. Environmental Health Department —COUNTY— "qP/ Greatness grows here Monitoring Well/Soil Boring Inspection Report Date: 14111 Inspector: ^4446i"` CONSTRUCTION Facility Address: Zld3 tr,l r i ,4s v''e' Well Address: Total Depth: WP# 512- Well#: Drilling Rig Type: Soil Boring#: Drilling Compan Min 2" Annular EHD Seal Verified: 11 Yes []No� act C'9� Driller Onsite: v�. �-�-� Screen Length From: To: Consultant: Filter Pack From: To: Geologist: A16 o•. 51 Tc Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: IT7 T height _QW—f SAMPLING ASOVE•GROUND Holding Temperature: COWLET1ON �+PLEnON Method: G=nd Swlacs Screening Method: groLn Verified Chain of Custody: ❑ Yes ❑No �_ft. ft. ft. SPOILS = Contamination Noted: ❑ Yes ❑No =" If yes, spoils storage Location: slotted a�cion _ Covered: ❑ Yes ❑No = vlw Pack If yes, material: GROUTING or DESTRUCTION Total Depth: 5 _ Depth to Water: r5` Grout Material: t0*ftj ['[Arne-e•t- MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation)6 Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity %Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas 2allons Bags Thickest Thinnest 4Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 1 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 1 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com