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SQNJOQQUIN Environme I Health Department —COUNTY Greatness grows here" Monitoring Well/Soil Boring Inspection Report Date: 3t�Z.\ Inspector: CONSTRUCTION Facility Address: \ Well Address: 3 Total Depth: WP# `�� Ile �� Well#:\�I-:)_ �\�v.�� Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Driller Onsite: h�J `C�` ) Screen Length From: To: Consultant: L Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes PNo COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: 0 Yes ❑No casing If yes, location and distance: l:p' height SAM P LI N G.,� J)N ABOVE-GROUND ckwrszi,aox . Holding Temperature: COWLET)ON cowLEn.oN Method: G=ndSurta" + Screening Method: 9r«n Verified Chain of Custody: ❑ Yes ❑No ft' ft. ft. SPOILS Contamination Noted: ❑ Yes IJNo a = If yes,spoils storage Location: stottQd Covered: I/Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: HJ A fL —ft. Grout Material: '�- Gallons of Grout Used: w o� MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation PWell 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�Tremie C/JOver Drill Filter Pack Type/Size: El Gravity ❑Other: Type of Method: Water Cement 471b Water Cement 941b gall Bags gallons Bags Thickest Thinnest NBags Thickest Thinnest #Bags 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 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 7 35 70 7 20 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 www.socehd.com