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SANIOAQUIN Environmental Health Department " _ f`_� —COUNTY Greotness grows here. Monitoring Well/Soil Boring Inspection Report Date: 3 2� Inspector: CONSTRUCTION Facility Address: e, Kq Well Address: Total Depth: V WP# Well#: Drilling Rig Type: Soil Boring#: " Min 2"Annular EHD Seal Verified: El Yes El No Drilling Company: Y Driller Onsite: [SSG, Screen Length From: To: Consultant: ��(,Y ,[�ryv Filter Pack From: To: ��'f� Bentonite From: To: Geologist: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABOVE-GROUND Holding Temperature: CO^'FLE'TION C.O&PLEnoN Method: Ground Sul=* Screening Method: al«A Verified Chain of Custody: ❑ Yes ❑No —`----n' SPOILS . n. 61- Contamination Noted: ❑ Yes ❑No $2— 20 f=t IOft If yes, spoils storage Location: on Covered: ❑ Yes El No so = $�I- 15�t loft' If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: ft. = IFft. Grout Material: �Q [ernA:1g4 Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation [Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity Tremie ❑Other: Type of Method: Water 1- Ment 471b Water Cement 94 lb allons gall ons Bags Thickest Thinnest ABags Thickest Thinnest VBags 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 1205 25 5 25 50 5 �SQ� U�0.�S GT 1, �an' ""' Vv I 15 30 6 30 60 6 v 17.5 35 7 35 70 7 96111 W a�c.r 6-a 20 40 40 80 8 J 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.secehd.com