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SAN 10A Q U I N Environmental Health Department i" COUNTY Greatness grows here. I _ Monitoring Well/Soil Boring Inspection Report Date: J� W�p�-�ector: J t D-- CONSTRUCTION Facility Address: l oZ� k�f Well Address: Total Depth: WP# l`) 0 4 1 tq Well#: Drilling Rig Type: Soil Boring#: 6I _ Drilling Company: Min 2"Annular EHD Seal Verified: EJ Yes ❑No �/1/,P�S--� � �� i'P�°N Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: �i�b�V J 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: 17 height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION COMP1,MON Method: Ground S"Taco Screening Method: Grout Verified Chain of Custody: ❑ Yes ❑No �ft• ft. ft. SPOILS = o Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: stonad _ B cn r Covered: ❑ Yes ❑No = V4 Pack If yes, material: GROUTING or DESTRUCTION Total Depth: S tT(K J __ Depth to Water: n tt. Grout Material: Gallons of Grout Used: 'N- S© 0-- MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation�6oring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Giravity ❑Tremie ❑Other: Type of Method: Water Ceme Llb Water Cement 941b allons Bas vallons 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 25 5 25 50 5 15 30 60 6 17.5 3 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