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= z SANs10AQUIN Environmental Health Department Z6" —COUNTY JGreatness grows here. Monitoring Well/Soil Boring Inspection Report pp Date: 2�2�w Inspector: t"�ncA`S�a 60 - L CONSTRUCTION Facility Address: Well Address: �Z � /t'�lY •�i'r <Iye � Total Depth: uk� y WP# y '//01 2 Well#: Drilling Rig Type: Soil Boring#: F)AA -1'�, Drilling Company: � o� � o�� Min 2„ Annular EHD Seal Verified: El Yes ❑No Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height cr— SAMPLING ABOVE-GROUND Holding Temperature: 0016FLET10N CCCUPLETioN Method: Ground Surf'” Screening Method: grout Verified Chain of Custody: ❑ Yes El No ---n' tt. ft. SPOILS Contamination Noted: ❑ Yes ❑No = o If yes, spoils storage Location: siottad a.cson Covered: ❑ Yes []No If yes, material: GROUTING or DESTRUCTION Total Depth: 29 ': __ Depth to Water: ft. n' Grout Material: GMATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction gags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b 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 3 10 20 4 20 40 4 12.5 1 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 40 80 8 / 1 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com