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SANd0AQUIN i Environmental Health Department —COUNTY— _, `•�sq.onN)�� Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date "I Inspector: DOk•gt)` ` CONSTRUCTION Facility Address: 230 :r�jnd ric tR Well Address: Total Depth: WP# C0'3 .(_Well#: SV10 Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: 604Co- DrillerOnsite: 17,e O Screen Length From: To: Consultant: R• eV f A 14n Z Filter Pack From: To: Geologist: 'SPw., Bentonite From: To: Grout From: To: Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: I ffT height SAMPLING ABOVE-GROUND c1¢ils7veox Holding Temperature: COMPLETIONIff cornplerioN Method: Ground Ssalaca Screening Method: a 1 3 ft.Verified Chain of Custody: El Yes ❑No b_ SPOILS = 7 s Contamination Noted: ❑ Yes ❑No `` - If yes,spoils storage Location: Blotted tacdon •I Covered: ❑ Yes ❑No c gravel pack If yes,material: f I GROUTING or DESTRUCTION Total Depth: Depth to Water: ol'u— Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: S Q a Casing Type: C6Well 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 47lb Water Cement 941b allons Bags allons Ba s Thickest Thinnest Mils Thickest Thinnest 4Bags Bententte/Cerra nt MIX 3% Mix 5%MIX 2.5 s 1 5 to 1 Bentonite per 47 1 1 IAIIJ 2.47 5 10 2 10 2a 2 Bentonite per 94lb 2.82 4.7 7.5 15 3 15 30 3 - 10 20 4 20 40 4 12.5 25 5 25 5 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 0 40 30 0 .y q 1/� 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com