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f arH� SAKJOAQUIN Environmental Health Department � 1 —COUNTY c� P! Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: \SI+k:� CONSTRUCTION Facility Address: �1 L1 5',.r�r F, f l vk, $fie r.l-Ir r Well Address: Total Depth: WP# � 0. �kti3tA Well#: Drilling Rig Type: Soil Boring#: $'( ' ,T Min 2" Annular EHD Seal Verified: El Yes ❑No Drilling Company: Driller Onsite: �� Screen Length From: To: Filter Pack From: To: Consultant: Geologist: 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: I T height SAMPLING ABOVE-GROUND Holding Temperature: COMPLETION COMPLETION Method: Ground Surface Screening Method: o'1O1t Verified Chain of Custody: ❑ Yes ❑No �ft. tt. ft. SPOILS <v = o Contamination Noted: ❑ Yes El No If yes, spoils storage Location: alonnd x- _ B sKion Covered: ❑ Yes ❑No _ g-V'w palcx If yes, material: ( _ GROUTING or DESTRUCTION Total Depth: t ' Depth to Water: tt' Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well 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 ❑Tremie ❑Other: Type of Method: 111 Water cement 4Vb Water Cement 94 lb R31111 s Bas izallons Bags Thickest Thinnest #Bags Thickest Thinnest ttBags 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 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.secehd.com