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SAN J 0AQ U IN Environmental Health Department - COUNTY - v,-a:" Greatness grows her,. Monitoring Well/Soil Boring Inspection Report Date: Z /7 Inspector: E� CONSTRUCTION 4 S Z 4 Facility Address: 73S l Well Address: Total Depth: WP# -0 3qOsC) Well#: Drilling Rig Type: ��R° i pk Soil Boring#: tt, t2 � , � Min 2 Annular EHD Seal Verified: El Yes El No Drilling Company: "T-�rr.�ec�L•- Driller Onsite:9461 -t- Screen Length From: To: -T1�ltoc,cm.1 Filter Pack From: To: Consultant: Geologist: K—ni Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: 00WPLErt0N COMP FnoN Method: Ground Surface Screening Method: n ori Verified Chain of Custody: ❑ Yes El No �ft' n. tt. SPOILS w Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: slotted = . apron — B Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: , =_ Depth to Water: Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Cit her: Type of Method: at em t 471b Water Cement 941b allo Bas allons Ba s Thickest Thinnest 4Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 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 11.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 106 Z o t/2- 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com