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FiL "� SAN�IOAQUIN Environmental Health Department —COUNTYPJ Greotness grows he e. Monitoring Well/Soil Boring Inspection Report Date: l0'1� Inspector: tire.�r•+sL CONSTRUCTION Facility Address: Well Address: IC'v,�5 C r1 -'10) 51-rr44n C,9- RSzIL Total Depth: 351- WP# C �- � (I L'1 Well#: Drilling Rig Type: Soil Boring#: P L, ?; i � -,) Min 2" Annular EHD Seal Verified: 1:1 Yes ❑No Drilling Company: e.d n F�,,��(F��'e,�i"c�� Screen Length From: To: Driller Onsite: ✓ Consultant: FSK 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 ABOVE-GROUND Holding Temperature: COMPLETION �OMPttEnON Method: Ground Surface Screening Method: grout Verified Chain of Custody: ❑ Yes El No n' ft. ft. SPOILS Contamination Noted: ❑ Yes ❑No a` If yes, spoils storage Location: slotted sec fon Covered: ❑ Yes 1:1 No = „01 If yes, material: _= GROUTING or DESTRUCTION Total Depth: Depth to Water: L n' Grout Material: A'Pa, C rod L MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: El Boring Installation PSBoring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: p Filter Pack Type/Size: ❑ Gravity ❑Tremie ClOther: kllC w"�I Type of Method: Water Cement X Ib Water Cement 4lb allons Bas gallons Bags Thickest Thinnest uBags 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 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 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 2D 40 8 40 80 8 5' A '-� T-\A � � 10/16/2017 S 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com