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pUIN SALMON N Environmental Health Department COUNTY— Greatness grows here. MonitoringaWell/Soil Boring Inspection Report Date: ��14 l7 Inspector: r P /1 CONSTRUCTION Facility Address: '1 30 Well Address: Total Depth: WP# 0 f7 3 WeWell#: SV 11 '� Drilling Rig Type: Soil Boring#:_ Min 2"Annular EHD Seal Verified: ❑Yes El No Drilling Company: aS Ca dA Screen Length From: To: Driller Onsite: O rig- Filter Pack From: To: Consultant: ti /�- Bentonite From: To: Geologist: 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: height I SAMPLING ABOVE-cRoUNc cI�t151y eOX Holding Temperature: COMPLETION ccmpt.Enoisi Method: Mound sutac Screening Method: PER gram I_Zq n. Verified Chain of Custody: ❑ Yes ❑No - . n, SPOILS = a Contamination Noted: ❑Yes []No �� c If yes,spoils storage Location: abst r , aecEon �f C Covered: ❑ Yes ❑No y,vap-k If yes, material: ��t2 GROUTING or DESTRUCTION Total Depthy -.C.9 F _ ' tt Depth to Water: ft. Grout Material: MATERIALS/DEVELOPMENT Gallons of Grout Used:_ U D 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: Water Cemen 471 Water Cement941b allons Bags Kalil 0ns Be s Thickest Thinnest ABags Thickest Thinnest nBae, BentonitelCement MIX 3% MIX 5%MIX 2.5 5 1 5 io 1 l8entonfle per 47 lb 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 lb .821 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 3S 70 7 20 1 40 8 40 80 8 10/16/2017 5 , 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com