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SAN 10AQ U I N Environmental Health Department " +'r . COUNTY - �ctrvga ` Greutness grows her. Monitoring Well/Soil Boring Inspection Report Date: Iit Inspector: (�l r�`r�t CONSTRUCTION Facility Address: 01'0 5. A-4-5 k-- lZ Well Address: Total Depth: WP# k 1-4A Well#: Drilling Rig Type: Soil Boring#: r0 _� I "� Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: (,��S ��- Screen Length From: To: Driller Onsite: g Consultant: ( vj'vs� Filter Pack From: To: Geologist: SS.L Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing IMIf yes, location and distance: T height SAMPLING AJ30VE-GROUND Holding Temperature: COMPLETION ccc+AP nciN Method: Gmnd surlac. Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �ft. tt. ft. SPOILS = Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: sloned = on Covered: ❑ Yes ❑No = t-vl+saok If yes, material: _= GROUTING or DESTRUCTION Total Depth: =_ t _ Depth to Water: (tj " tt• tt. Grout Material: W Gallons of Grout Used: � �a,LCv� S MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation L�Boring Destruction gags iz 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 471b Water Cement 941b allons Bas wallons Bags Thickest 1. Thinnest #Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5%Mix 2.s s 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com