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g SANdOAQUIN Environmental Health Department COUNTY— woa P Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: I lit p'lL Inspector: CONSTRUCTION Facility Address: ../'4 Bwt11 M4u Ihh �hTePL� Well Address: Total Depth: WP# etp �A 14. I g Well#: Drilling Rig Type: Soil Boring#: - - 3 . 0-4 , _ lIQ Min 2"Annular EHD Seal Verified: ❑ Yes 1:1 No Drilling Company: 4y ULOr;1 ` .n Driller Onsite: 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: ++ T height T SAMPLING ABOVE-GROUND Holding Temperature: COWPLETION ccmptEnoN Method: Ground Surface Screening Method: arocrt Verified Chain of Custody: ❑ Yes El No �ft' ft. ft. SPOILS a Contamination Noted: ❑ Yes El No = If yes, spoils storage Location: abnod ,a on Covered: ❑ Yes ❑No = gravel If yes, material: p tiia3 9g GROUTING or DESTRUCTION Total Depth: IF 2d�k' Depth to Water: ft• ft' Grout Material: E Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation Woring Destruction gags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie [Other: -P Type of Method: Water Cement 47 Water Cement 94 lb allons Ba allons Bags Thickest Thinnest ttBags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 s 1 s 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 is 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 S S `O ,24 be'y� 10/16/2017 1868 E. Haze-ton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com