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SANv.IOAQUIN Environmental Health Department —COU NTY— °�cc�`° / Greotness grows here. o Monitoring Well/Soil Boring Inspection Report M Date: '014 Inspector: wol SLa r��w�, CONSTRUCTION Facility Address: 2 Well Address: 1171 �'t�Clot, ,� 5�, � a�� Total Depth: G WP# ycp ML Well#: Drilling Rig Type: Soil Boring#: `t\Sly Drilling Company: �� Min 2"Annular EHD Seal Verified: El Yes 1:1 No g p y:��l�r��,?�,, 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 El No casing If yes, location and distance: height SAMPLING ABOVEGROUND Holding Temperature: COMPLETION COMPLETION Method: Graind Surfws Screening Method: grout Verified Chain of Custody: ❑ Yes El No �ft. it. it. SPOILS 4 Contamination Noted: ❑ Yes ❑No r" If yes, spoils storage Location: slattad sacion ,y Covered: ❑ Yes ❑No = 9-01 P--k If yes, material: ` =_ GROUTING or DESTRUCTION Total Depth: l0 �, :'• =_ Depth to Water: Grout Material: ., Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity 12`fremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bags izallons Bags Thickest Thinnest uBags Thickest Thinnest VBags 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 is 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 s0 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 952051 T 209 468-3420 1 F 209 464-0138 I www.socehd.com