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$ANdOAQUIN Environmental Health Department <br /> —COUNTY— <br /> „ _ Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Datel A6Aj Inspector:�L ,1 e j CONSTRUCTION <br /> Facility Address: 4311 6 L u eGl4 r_t i1 r <br /> Well Address: Total Depth: <br /> wP#Wg5371- Well#: Drilling Rig Type: <br /> Soil Boring#: tM tA..- 1 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: 65 <br /> DrillerOnsite: 7cteda Screen Length From: To: <br /> Consultant: �1K fteLa,� Filter Pack From: To: <br /> Geologist: Xeit?i(ct✓1 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic WellOnsite: El Yes ❑No casing <br /> If yes, location and distance: � height T <br /> SAMPLING ABOVEGROUND T <br /> COWLETION COMPLEnoN <br /> Holding Temperature: coMal.aTioN <br /> Method: Orwndsufac9 <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes El No <br /> ft. <br /> SPOILS <br /> � _ e <br /> Contamination Noted: ❑Yes ❑No ° <br /> If yes,spoils storage Location: <br /> wrJon Frj _ $ <br /> Covered: ❑Yes ❑No — gnival pack <br /> If yes, material: ] <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: qt 1t <br /> Grout Material: ✓iCu Cewtew MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: 5 0 5 C.,I Casing Type: <br /> ❑Well Installation CpNell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water cement 471b Water Cement 941b <br /> allons Bags gallons Sao <br /> Thickest Thinnest pBags Thickest Thinnest NBags Bentonite/Cement Mix 3%Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb I 1AIII 2.47 <br /> 5 10 2 le 20 2 Bentonite per 94 lb 2.821 4.7 <br /> 7.5 15 3 15 30 3 <br /> 30 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 <br /> 20 40 a 40 eo e <br /> O buns LAScc.l 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com <br />