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SAKAAQUIN Environmental Health Department •.l COUNTY �4c P Greatness grows fi •. Monitoring Well/Soil Boring Inspection Report Date: Inspector: S• �tl')') aVMf 9'gCONSTRUCTION Facility Address: aI� N. N1A� Lev, — HU �-G{2 Well Address: IWASamn Total Depth: WP#25t M015q Well#: Mh!Q Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: b� Driller Onsite: (�1,1�1e Screen Length From: To: Filter Pack From: To: Consultant: Geologist: 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: height iii SAMPLING ABOVE-GROUND Holding Temperature: COWPLErXDN comPLEnON Method: Ground Surfac* ' +_ Screening Method: 01 grout Verified Chain of Custody: ❑ Yes ❑No eft. tt. ft. SPOILS a' Contamination Noted: ❑ Yes ❑No = If yes, spoils storage Location: stoned _ B sac:on - — Covered: ❑ Yes ❑No = � If yes, material: zK = a — GROUTING or DESTRUCTION Total Depth: 't\, ; =_ Depth to Water: Grout Material: Gallons of Grout Used: 1\� \per MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation Nell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ver Drill Filter Pack Type/Size: ❑ Gravity Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b Fall Bags gallons Bags Thickest Thinnest 9Bags Thickest Thinnest tlBags Bentonite/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 10 20 4 20 40 4 (q 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 F 209 464-0138 1 www.s*cehd.com