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COONTY- -QQ- Environmental Health Department -COUNTY- Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: I 10(`I Inspector: v ' CONSTRUCTION Facility Address: -�� Well Address: Total Depth: 35 WP# 4n I Well#: 9611,5 7 Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: l Driller Onsite: �� 5-� S j Screen Length From: To: Consultant: j.rtS>/1 �S I� Z Filter Pack From: To: Geologist:� � entonite From: To: J�I Grout From: To: Public Water System Onsite: ❑ Yes ❑No ft SSCOMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height i SAMPLING ABOVE-GROUND Holding Temperature: CONPLETtON COMPLETION Method: Ground Sumacs Screening Method: groat Verified Chain of Custody: ❑ Yes ❑No ft• ft. ft. SPOILS y" - ,K t=F: ' . Contamination Noted: ❑ Yes ❑No r` If yes, spoils storage Location: stoned — 3 sac�on M Covered: ❑ Yes El No ', gra„+pack If yes, material: — GROUTING or DESTRUCTION Total nth: cll- 3r . Depth to Water — h Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation Awell Destruction Blank Feet Screen Feet ❑Boring Installation ❑ Slot Size: Boring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity AT, remie ❑Other: Type of Method: V 'k ; /" Water Cement 471b Water Cement 941b allons Bags eallons Bags Thickest Thinnest " 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 s 10 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 is 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com