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SAKdOAQUIN -P� —COUNTY--- Environmental Health Department �O�t,Faas'/ Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 1200 Inspector:,(:1d t-P-r+ CONSTRUCTION Facility Address:_ v l f1'1Z � i A 4 It Well Address: ^ " Total Depth: WP#00q C) C) 0 Well#: Drilling Rig Type: Soil Boring#: 2-P-2 ) " O f Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Screen Length From: To: Driller Onsite: a Consultant: cr -d Filter Pack From: To: Geologist: Bentonite From: To: I YV`' 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: ITTLT height SAMPLING ABOVE-GROUND Holding Temperature: 001"F�ION TIO TCOMPLEN Method: G=nd S"t"' ' T Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �n. n. it. SPOILS Contamination Noted: ❑ Yes El No If yes,spoils storage Location: slotted sacdon Covered: ❑ Yes ❑No = gL-vW pack If yes, material: GROUTING or DESTRUCT ON Total Depth: ( 6 Depth to Water: n• n' Grout Material: r� MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation-NBoring 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 Cement 471b water Cement 94 lb 17"allo Bag gall ons Bags Thickest Thinnest 4Bags Thickest Thinnest VBags Bentonite/Cement Mix 3% Mix 5% Mix 2.s s 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 2 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 5 25 50 5 15 30 6 30 60 6 17.5 5 7 35 70 7 2 0 $ 40 80 1 8 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com