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"aclk S A N J 0 A 0 U I N Environmental Health Department i " W J —COUNTY--- Greatness COUNTY-- Greatness grows here- Monitoring Well/Soil Boring Inspection Report Date: ZO Inspector: J kk'*_t t CONSTRUCTION Facility ddress: 7 31 CGS WA-U i Well Address: Total Depth: WP#_n0ti103/4 Well#: Drilling Rig Type: - Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: Screen Length From: To: Consultant: QS K La,4-0 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 iii SAMPLING A80VE-GRCUND Holclung Temperature: CONFLETtON c�t-EnON Method: G=nd Sudan Screening Method: or«n Verified Chain of Custody: ❑ Yes El No -�—n' n. n. SPOILS = .: Contamination Noted: ❑ Yes ❑No C If yes, spoils storage Location: slotted sacyon Covered: ❑ Yes ❑No = gravel Pack If yes, material: GROUTING or DESTRUCTION Total Depth: =_ Depth to Water: '' — f n- n' Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ly"oring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity IIITremie ❑Other: Type of Method: Water cemenf471b Water Cement 941b allons gall ons Bags Thickest Thinnest 1t Bags Thickest Thinnest "Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 1 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 1 15 30 3 10 20 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 1 www.sacehd.com