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SARdUAUUI� � Environmental Health Department rt•' —COUNTY— , _ Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: it�4/18 Inspector: CONSTRUCTION Facility Address:30 WO S ps•r et Wv Well Address: Total Depth: WP# 003i651 Well#: Drilling Rig Type: Soil Boring#: -1010 „ era - Min 2 Annular EHD Seal Verified: El Yes ❑No Drilling Company: Driller Onsite: tz w� il�u+�,(� Screen Length From: To: Consultant: ^�6✓✓! Filter Pack From: To: �I Bentonite From: To: Geologist: k64 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: nei-glit SAMPLING ABOVE-IbRC ND , Holding Temperature: co.)) LE joN cC-O LETiON Method: Grocind Su faco Screening Method: groat Verified Chain of Custody: ❑ Yes ❑No ' SPOILS = wpF Contamination Noted: El Yes ❑No = o If yes, spoils storage Location: = r Covered: ❑Yes ❑No 'w If yes, material: GROUTING or DESTRUCTION Total Depth: —7 l EE Depth to Water: _tm-r+t_ Grout Material:�x C - Gallons of Grout Used: !� -A-'Zp MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation oring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout Dover Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity G?(emie ❑Other: Type of Method: Water Cement 47 lb Water Cement 941b gallons Bas Rall ons Bags Thickest Thinnest #Bags 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 5 l0, 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 75 15 3 15 30 3 10 20 4 20 40 4 jj � 12.5 25 5 25 50 5 ' {7(Tl 1 15 30 b 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 — 8 4-7 1 J 10/16/201.7 'i -I 6b) I, 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 2D9 64-0138 i www.sicehd.com f- �� 3 ,? S rnr.�