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SAWJ0A0UIN Environmental Health Department COUNTY — 1c' Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date:3/It/26 Inspector: CONSTRUCTION Facility Address: th Well Address: Total Depth: WP# 3601jjo Well#: W. w1_Z Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: (Cj^k'(µr,ACe Driller Onsite: lc.�wii e. �ict4c � 'Ike•- Screen Length From: To: Consultant: wtad' XCI-6l- Filter Pack From: To: Geologist: Cl/ .'-Les 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: WT height SAMPLING ABOVE-GROUND C-HR__ Holding Temperature: CONFLETION COMPLETION Method: Ground Surlacs Screening Method: grout Verified Chain of Custody: ❑ Yes El No tt. tt. SPOILS = Contamination Noted: ❑ Yes El No If yes, spoils storage Location: stow ax.on = Covered: ❑ Yes ❑No = ¢, 'w Pack If yes, material: r GROUTING or DESTRUCTION Total Depth: Depth to Water: Grout Material: vi emk Ce&.v^e✓4 Gallons of Grout Used: �O a�I MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation TWell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout [Over Drill Filter Pack Type/Size: ❑ Gravity I)4Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94lb gall Bags gallons Bags Thickest Thinnest 9Bags Thickest Thinnest dBags 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 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.s*cehd.com