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f SAN• ' '°P� Environmental Health Department —COUNTY-- Greatness COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: 8 CONSTRUCTION L� ISS o DFacilityAddress. J S� F 67 Lst Well Address: Total Depth: WP# oomqr Well#: Drilling Rig Type: Soil Boring#: ,� �, Drilling Company: �' � riu ti Min 2" Annular E ❑ ❑ HD Seal Verified: Yes No Driller Onsite- Screen Length From: To: Consultant: 4 -V N� C Y lnlC. Filter Pack From: To: rf�o Bentonite From: To: Geologist: 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 W7F SAMPLING ASOVE-GROUND Holding Temperature: COWPLET{ON COMPtEnil Method: Gmnd Sutsn Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No ft. ft. SPOILS 0 Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: abn�e .on x. Covered: ❑ Yes ❑No = grave,Pack If yes, material: GROUTING or DESTRUCTION Total Depth:-2-0� =_ Depth to Water: Grout Material:T MATERIALS/DEVELOPMENT Gallons of Grout Used: 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 []Other: Type of Method: Water ent 47)b'\, Water Cement 94 lb allons Bas gall ons Bags Thickest Thinnest uBags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 z 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 25 25 50 5 15 30 6 30 60 6 17.5 35 7 1 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com