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"�U'" ' SANdOAQUIN Environmental Health Department W,') —COUNTY--- w� "� Greatness grows here. Monitoring Well/Soil Boring Inspection Report C Date: iU 2 Inspector: �l`1fx0yS CONSTRUCTION Facility Address: TYucy Well Address: Total Depth: WP# -)Dq1 Well#: Drilling Rig Type: Soil Boring#: � Min 2"Annular EHD Seal Verified: L1 Yes ❑No Drilling Company: YV� rl Driller Onsite: W4?_ t4 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: WT height SAMPLING ABOVE-GROUND Holding Temperature: CONFLETION cornoN Method: Ground surf"' '"+ Screening Method: grow Verified Chain of Custody: ❑ Yes El No �---n' it. SPOILS Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: slotted _ 3 soction — Covered: ❑ Yes ❑No = g-VWPack If yes, material: GROUTING or DESTRUCTION Total Depth: 116w_ —_ Depth to Water: v) n' Grout Material: �p(Av CRVq0 Gallons of Grout Used: 'j pinm11 _ MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction t•1v\ Blank Feet Screen Feet ❑Boring Installation (Boring Destruction dii amw Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ;KTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas gallons Bags Thickest Thinnest 9Bags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 3%Mix 2.5 5 1 s - 10 1 • Bentonite per 47 Ib 1.41 2.47 s 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 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com