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rauiro c SANr10AQUIN Environmental Health Department —COUNTY— Greatness grows here. Monitoring�Well/Soil Boring Inspection Report Date: W lt(igai Inspector: �cw�ra 5 � `'uli;H ;L CONSTRUCTION Facility Address: Well Address: '1.1;� �� '. ��i g1 den Total Depth: WP# o�T�I Well#: Drilling Rig Type: Soil Boring#: � `� Drilling Company: Min 2" Annular EHD Seal Verified: [I Yes ❑N Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: lit. r, ��,:��.�a 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: �M. 9— —ow, T height SAMPLING ABOVE-GROUND Holding Temperature: CO&FLETION COMPLETION Method: ti=na Suta<. Screening Method: grout Verified Chain of Custody: ❑ Yes El No �it. tt. tt. SPOILS — Contamination Noted: ❑ Yes ❑Novo =' If yes, spoils storage Location: stoned axon Covered: ❑ Yes ❑No = g-vW pack If yes, material: _ GROUTING or DESTRUCTION Total Depth: IF _= Depth to Water: n- = n- Grout Material: rr ..,• MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation C Boring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie [-Other: ��!;.^ Type of Method: Water Cement 471b Water Cement 94 lb allons Bas gallons Bags Thickest Thinnest ttBags 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 25 5 25 50 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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com