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SAN 10AQUIN t< Environmental Health Department y COUNTY "Stir.r,P��t' Vf"t'QP77P.SS �f!)i`dS �7P_f'£. Monitoring Well/Soil Boring Inspection Report Date: /1 Z2 Inspector: J C �� CONSTRUCTION Facility Address: 2 S'oo Na.yy _�Ar' , Sx(: &�`70 Well Address: Total Depth: WP# 00�3 91,81 Well#: Drilling Rig Type: Soil Boring#: Drilling Company: e7te- CoY'e Min 2" Annular EHD Seal Verified: ❑ Yes []No Driller Onsite: TJi q.l�. G f � ,�Vri'�..n Screen Length From: To: Consultant: Ge-o�sys�ae Filter Pack From: To: Geologist: Jed n (-��/' 7� %r-~✓ 1 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: height SAMPLING AWVE-GROUND Holding Temperature: COMPLETION COMPLEn-ON Method: c3=r)d S sac, Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No n- it. ft. SPOILS Contamination Noted: ❑ Yes ❑No _ If yes, spoils storage Location: sWl� y•' � soon Covered: ❑ Yes ❑No _ kw ��♦� If yes, material: ` — ti GROUTING or-DESTRUCTION Total Depth: Depth to Water: tt- Grout Material: ?lewd`' Cen e-n rt- Gallons of Grout Used: ""�S �(j � S MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation Well Destruction Blank Feet Screen Feet ❑Boring Installation ❑Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity remie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bags Rallons Bags Thickest Thinnest JdBa s Thickest Thinnest 78ags Bentonite/Cement Mix 3% Mix 50% 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 lb 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 ( Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sicehd.com