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SAW]OAQUIN Environmental Health Department �}-- COUNTY- ir' 'clFoa'i\', Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 3�I Inspector: m CONSTRUCTION Facility Address: 2&(A\ fgat ' 112 Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: TDL 10 Drilling Company: 1 V Min 2" Annular EHD Seal Verified: El Yes ❑No Screen Length From: To: Driller Onsite: Consultant: F` P Filter Pack From: To: %Geologist: ��tiys„� Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes �allo COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes �41\lo casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION COMPLETION Method: Ground S"ri"' Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No ----n' tt. ft. SPOILSAll . Contamination Noted: ❑ Yes El No — If yes,spoils storage Location: .toted aactian -- � Covered: ❑ Yes ❑No = v ack If yes, material: GROUTING or DESTRUCTION Total Depth: =_ Depth to Water: i,� ' — tL n Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation XBoring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: &Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity NTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas vallons 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 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 20 4 20 40 4 1205 25 5 25 50 5 �n �C� (,� ZZ 15 30 6 30 60 6 17.5 35 7 35 70 7 01\ V al .)( Qom! o'i'nP kA 20 40 8 40 80 8 51 61 r 311 ' 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com