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SAK JOAQUIN Environmental Health Department - COUNTY -- Greotness mews her,,'. Monitoring Well/Soil Boring Inspection Report Date: Inspector: CONSTRUCTION Facility Address: IVoy✓ Well Address: Total Depth: WP# 0»3'tqYL/ Well#: Drilling Rig Type: Soil Boring#: ' Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Pam/."' Screen Length From: To: Driller Onsite: ��r�.�c e, Cst•a,w�cc Ca-,s1 Filter Pack From: To: Consultant: Geologist: OLNA Do J'4h , 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 SAMPLING ABOVE-GROUND Holding Temperature: cotFnN cOMPLEnc � O N Method: Ground 8urfw* Screening Method: Rt grout Verified Chain of Custody: ❑ Yes ❑No tt. ft. SPOILS = Contamination Noted: ❑ Yes ❑No = C If yes, spoils storage Location: ston&e sacdon Covered: ❑ Yes El No — g-vwt pack If yes, material: ' GROUTING or DESTRUCTION Total Depth: 45 . Depth to Water: R.u4- —ft. IF = IF tt. Grout Material:��,, - �„vv...r — MATERIALS/DEVELOPMENT Gallons of Grout Used-'lo,, ,— 40,h Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Borin Installation Slot Size: g oring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity 94T5e m i e ❑Other: Type of Method: Water Cement 471b Water Cement 941b gall Bags gallons Bags Thickest Thinnest ttBags Thickest Thinnest uBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 15 3 15 30 3 10 20 40 4 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com