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SANsd0A0UIN Environmental Health Department CC33 � —COUNTY- c, rj Greatness grows here. �J 1 Monitoring Well/Soil Boring Inspection Report Date:I a`�I ` Inspector. CONSTRUCTION Facility Address: 90 V✓ L; vii-Irt Well Address: Total Depth: WP#Qj 41 5q4 Well#: Drilling Rig Type: Soil Boring#: 16 6,00 2— i5 G—bo —T, � Drilling Company: PiI�C�Cfl✓'•e ; � % Min 2"Annular EHD Seal Verified: El Yes L1 No Driller Onsite: Screen Length From: To: Consultant: �P� V? ef, Filter Pack From: To: Geologist: L-au. r'q,i Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: T height _V1 I SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION C�LEnoN Method: Ground Surface Screening Method: ori Verified Chain of Custody: ❑ Yes ❑No �tt. ft. tt. SPOILS . Contamination Noted: ❑ Yes ❑No — If yes, spoils storage Location: stoned = . sec5on Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: �O �1 CX ✓ -_ Depth to Water: rl U )-ft. tt' Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installatiot boring Destruction Bags of 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 Cemen 471b Water Cement 941b allons Bas allons Bags Thickest Thinnest 11 Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 s 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 2s 5 25 so s is 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 I d /,&.1 t/. LV 5 10/16/2017 1868 It. Hazelton Avenue I S l ckton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com