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SAN 10AQUIN Environmental Health Department COUNTY-- `',o� o Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: / t!I / l Inspector: ror'a A CONSTRUCTION Facility Address: 10 (c, I ),,,L ck haw C4, Well Address: Total Depth: CO W P# "j 9:8+ Well#: Drilling Rig Type: &,q Soil Boring#: I Z Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: T4-- Driller Onsite: v- Screen Length From: To: Consultant: W0. P{ h Filter Pack From: To: Geologist: OS Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No caging If yes, location and distance: height ii SAMPLING Agpyg.GgpLINp Holding Temperature: CONFLEr10N COMP�L.ET oN Method: Ground Surf=* Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �it. till. ft. SPOILS Contamination Noted: ❑ Yes ❑No r` If yes, spoils storage Location: started sec�on Covered: ❑ Yes ❑No If yes, material: _- GROUTING or DESTRUCTION Total Depth: 10 P4 Depth to Water: /Va n- fL Grout Material: AAen MATERIALS/DEVELOPMENT Gallons of Grout Used: qed Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation�Boring Destruction gags iz 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 71b Water Cement 941b allons Bas allons Bags Thickest Thinnest NBags Thickest Thinnest zBags Bentonite/Cement Mix 3% Mix 3%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 2 Bentonfte per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 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 8 40 80 8 Z© q 1 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com