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C�/ � SANAOAQUIN Environmental Health Department ` —COUNTY — Greotness grows here. MonitoringWell/Soil Boring Inspection Report Date: I ��IZal Inspector: &2 iJ SYs�c��C1;2 l.. (Lv, CONSTRUCTION Facility Address: %\,A.\ N\LL\g. +n \, Well Address: I Total Depth: V4- WP# " L\1)6" Well#: Drilling Rig Type: Soil Boring#: \\Q\ - 30 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: (,S is xolg�ann Driller Onsite: ri Screen Length From: To: Consultant: 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: I T height 4_ SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION CCCMP�LET1oN Method: Ground Surfaon Screening Method: grout Verified Chain of Custody: ❑ Yes El No �tt. tt. tt. SPOILS _ _ .: a Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Blo ttad arrc'1an Covered: ❑ Yes ❑No pravwd pads If yes, material: GROUTING or DESTRUCTION Total Depth: -IF _= Depth to Water: fL — n• Grout Material: 13tc, MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Size: ❑Boring Installation 1 kBoring Destruction Bags Slot Siziz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity FPfremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest ttBags Thickest Thinnest 4Bags 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 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 40 80 8 � ,��S 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com