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osauiN c w�- � SHAWN Environmental Health Department a J COUNTY- 917 Greatness grows here. Q� Monitoring Well/Soil Boring Inspection Report Date: Alt 2 I Inspector: kti Y CONSTRUCTION Facility A dress: IH Wq ` 1 Well Address: Total Depth: WP# 00 4100-0- Well#: Drilling Rig Type: Soil Boring#: 3 r Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: W 'D " Driller Onsite: Knue Screen Length From: To: Consultant: Filter Pack From: To: Geologist: 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 naovE-GaouND Holding Temperature: CO�"PLETION ccCMPLEnON Method: GmndSi""' Screening Method: grout Verified Chain of Custody: ❑ Yes 1:1 No y---n' ft. tt. SPOILS Contamination Noted: ❑ Yes El No = If yes, spoils storage Location: abttad _ B s�c:on Covered: ❑ Yes ❑No = gni,,iw pack If yes, material: GROUTING or DESTRUCTION Total Depth: _= Depth to Water: n• n' Grout Material: N eAf e.iVXiiT Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation),Boring Destruction Slot Size: 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 cement 471b Water Cement 941b allons Bas allons BaR5 Thickest Thinnest 4Bags Thickest Thinnest It Bags Bentonite/Cement Mix 3% MIX 5% MIX 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 s 10 2 10 20 2 Bentonite per 94 Ib 2.821 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 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s'cehd.com