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r- )AIV_JIJAQUII� Environmental Health Department C O U N T Y— Greotness grows here. Monitoring Well/Soil Boring Inspection Report Date: (0/t.,4 lit Inspector: L01 CONSTRUCTION Facility Address: RgoF "I Well Address: Total Depth: WP#_ (703n It' Well#: Drilling Rig Type: Soil Boring#: Drilling Company: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Driller Onsite: 'T�Ic✓ Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑Yes ❑No cas5.ng If yes, location and distance: J�T h=_Ight ' .. SAMPLING ABovE-6ROUND Holding Temperature: co.w�t°N CCoMponxt Method: Screening Method: fL proui Verified Chain of Custody: ❑ Yes ❑No _fL 11. #t. SPOILS r = Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: :>ar sss-;ton w Covered: ❑Yes []No If yes, material: GROUTING or DESTRUCTION Total Depth: 15-0 _ Depth to Water: Grout Material: Ld -3 Gallons of Grout Used: MATERIALS/DEVELOPMENT --// Casing Type: V ell Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation ❑Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout Dover Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity Q riremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b Ilons sap gallans Bags Thickest Thinnest 4Bags Thickest Thinnest #Bags SentonitefCement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10' 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7,5 15 3 i5 30 1 3 1 1 i 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 B 1 40 80 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.slcehd.com