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SANIOAQUIN Environmental Health Department -`i —COUNTY-- Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: CONSTRUCTION Facility Address: SK 121) 6C1IC tP 1 fi`l n�k1f� Wal h�ur� Well Address: Total Depth: CPT ted, DT—— 2 2 WP# 00'A r379 Well#: Drilling Rig Type: Soil Boring#: R—20'CS— / 4r— ILj Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: Gin :F;�G Driller Onsite: �O'�u � U.r I� Screen Length From: To: Consultant: Gni� Filter Pack From: To: Geologist: �4'vy� 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: W- T height � SAMPLING ABOVEGROUND Holding Temperature: COWLETON CCoenP ON Method: Groind Surface Screening Method: er«� Verified Chain of Custody: ❑ Yes El No n. n. SPOILS . Contamination Noted: ❑ Yes E]No If yes,spoils storage Location: stonad s*cdon Covered: ❑ Yes ❑No _ gravol Pack If yes, material: _= �Lo-3oft GROUTING or DESTRUCTION Total Depth. • =_ Depth to Water: ^' 1215 n• n• Grout Material: N2 Old' aWNk✓l- MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring InstallationV Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity *Tremie ❑Other: Type of Method: Water Cement 4716 Water Cement 94 lb allons Bas gallons Bags Thickest Thinnest r7 Bags Thickest Thinnest nBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1. 5 10 1 Bentonite per 47 Ib 1.41 2.47 s q 10 10 20 2 Bentonite per 94 Ib 2.82 4.7 7.5 ILI 15 15 30 3 10 20 4 20 40 4 12.5 25 5 25 s0 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 1 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.s'cehd.com