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S A N J 0 A Q U I N Environmental Health Department " I_:i> COUNTY ogrrr,' Greatness grows here. n Monitoring Well/Soil Boring Inspection Report Date: 3 Inspe tor: t/o CONSTRUCTION Facility Address: r, U� Well Address: Total Depth: WP#AaNS'(V-t Well#: Hw- Drilling Rig Type: Soil Boring#: W ' MW)^ %in 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: cace, Screen Length From: To: Driller Onsite: Consultant: Filter Pack From: To: Geologist: �ot r Bentonite From: To: 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: WT height SAMPLING ABOVE-GROUND Holding Temperature: colFLEr>°N cCO6Un_EnON Method: Ground Surfacs Screening Method: orb Verified Chain of Custody: ElYes ❑No �ft' ft. ft. SPOILS = = m Contamination Noted: ❑ Yes El No = If yes, spoils storage Location: slotted sac on '— 2 Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: _ Depth to Water: -ft. A = ft. Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT \� Casing Type: ❑Well Installation ell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction caps Bags of Cement: METHOD USED 00�00M Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 47lb Water Cement 94lb Pall Bags gallons Bags Thickest Thinnest ttBags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 lb 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 1 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com