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Environmental Health Department !` —COUNTY— Greatness grows here. 'r� Monitoring Well/Soil Boring Inspection Report Date: 3 �v� Inspector: S+ I')')r1 OVDhOfA CONSTRUCTION Facility Address: VX LQh_f� tzway1ya Well Address: Total Depth: WP#X&NG25 Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Wt 9:?,, bLjl�l� Screen Length From: To: Driller Onsite: Consultant: 61044ni000 AML 116LIIIJ Filter Pack From: To: Geologist: Koroan Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ",�hristie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: T height SAMPLING ABOVE-GROUND ISTY_ Holding Temperature: �r F�1ON COWLS oN Method: Ground SLeacs Screening Method: procrt 2,51 -Q)` Verified Chain of Custody: ❑ Yes El No �---n' 2.5 V3'� SPOILS Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: sb d = �� - cSce� sacton = B ( � 1s I RemCovered: ❑ Yes ❑No = t `�1 If yes, material: C GROUTING or DESTRUCTION Total Depth: EEL _ Depth to Water: Nmp, Grout Material: NUA CAM Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bags eall s Bags Thickest Thinnest 1tBags Thickest Thinnest #Bags Benton lte/Cement MIX 3% MIX 5% MIX 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 lb 2.82 4.7 7.5 15 3 15 30 3 110 20 5 25 5 25 50 5 So l v ap o p- pub' 15 30 6 30 1 60 17.5 35 7 35 1 70 7 20 40 8 1 40 1 80 8 �(� . I ISM 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.swcehd.com