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SAKJOAHIN ' � �• Environmental Health Department , rLTAh ` ` —COUNTY— Greatness grows here I2'2y nv� Monitoring Well/Soil Boring Inspection Report 1 ..30 r Date: Ins p tor: ( t, CONSTRUCTION Facility A dre s: Well Address: Total Depth: WP# C) Well#: Drilling Rig Type: Soil Boring#: e2A Drilling Company: Min 2" Annular EHD Seal Verified: ❑ Yes El No Driller Onsite: jZtt Yv-� �� Screen Length From: To: Consultant: (, Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes El No casing If yes, location and distance: 37 height SAMPLING ABOVE-GROUND Holding Temperature: COWP ETION C�t.EnON Method: Ground Suriacs Screening Method: Rt e7l, grout Verified Chain of Custody: ❑ Yes El No tt. tt. SPOILS k — o Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: abn�d ,mon Covered: ❑ Yes ❑No If yes, material: Y GROUTING or DESTRUCTION Total Depth:2\ 21 3 Z�'/Z` Depth to Water: n• n- Grout Material: '&21A QXAN4\ �� _- ti MATERIALS/DEVELOPMENT Gallons of Grout Used Casing Type: ❑Well Installation ❑Well Destruction) 1 Blank Feet Screen Feet ❑Boring Installation ❑Boring Destruction `e 0 lW' Slot Size: _` Bags of Cement: METHOD USED 'j,��Jlr , Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill 111 . Type/Brand of Bentonite: Filter Pack Type/Size: El ❑Tremie ❑Other: rA• \ Type of Method: Ow Ce nt 471b Water Cement 941b allons Bas gallons Ba s Thickest Thinnest 1t Bags 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 s 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 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.s*cehd.com