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SAN 10AQUIN Environmental Health Department —COUNTY Greatness grows here. O� Monitoring � ,W, fell/Soil Boring Inspection Report Date: I Inspector: S�N�►`�-l/� CONSTRUCTION Facility Address: CO S 1 &yjn, , V// N3-A Well Address: Total Depth: WP# DGLt 01 Well#: Drilling Rig Type: Soil Boring#: ! c� Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: CYC wJ ei Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: 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: W— T height SAMPLING A80 VE-GRCCJNp CHRIMHolding Temperature: COWLEr10N cLE_ncN Method: G=nd Sur1w* Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No —n' it. tt. SPOILS = v1 a Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: slotted .on Covered: ❑ Yes []No If yes, material: GROUTING or DESTRUCTION Total Depth: 20"Pe =_ Depth to Water:--, 1" .f e I n• tt' Grout Material: N cb MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation 1Boring Destruction Bags of Cement: METHOD USED // Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity T�ATremie ❑Other: Type of Method: Water Cement 4716N, Water Cement 941b gallons Bas allons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags 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 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 0 1 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.secehd.com