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� aUr" �� SAN Environmental Health Department COUNTY Greatness grows here , Monitoring Well /Soil Boring Inspection Report Date , tlJInsliectors /►r1� CONSTRUCTION Facility Address : '" to 7,S J1 �' " Well Address : Total Depth : WP # v, ! 03 Well # : �(f Drilling Rig Type : Soil Boring# : s' Min 2 " Annular EHD Seal Verified : ❑ Yes ❑ No Drilling Company : ylltsAlwl Screen Length From : To : Driller Onsite : bb Consultant : Ae 4 6:ia Filter Pack From : To : Geologist : /Zr�- � 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 : height SAMPLING waovE-GR0UND Holding Temperature : COW' LETIOM COMPtEMN Method . around Surf w* " + Screening Method : arm Verified Chain of Custody : ❑ Yes ❑ No ENESNE6 n' He ft. SPOILS = _ Contamination Noted : ❑ Yes ❑ No If yes , spoils storage Location : stoned = = sacron = S Covered : ❑ Yes ❑ NoVRVW Pack If yes , material : h GROUTING or DESTRUCTION Total Depth : 1=s14 r `_� _ Depth to Water : ?� ft. n' Grout Material : P44"tt Ce -ou ss Gallons of Grout Used : 36 MATERIALS/ DEVELOPMENT Casing Type , ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet ` Slot Size : ❑ Boring Installation C�Boring Destruction Bags iz Cement : METHOD USED Bags Sand / Gravel : ❑ Pressure Grout ❑ Over Drill Type/ Brand of Bentonite : Filter Pack Type/Size : ❑ Gravity Mremie ❑ Other : Type of Method : Water Cement 471b Water Cement 941b gallons Bas gallons 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 2047 s 70 s72 10 20 2 Bentonite per 94 Ib 2082 4 . 7 7, 5 15 3 15 30 3 10 1 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 Stockton , California 95205 T 209 468 - 3420 F 209 464- 0138 www . socehd . com