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SQ C-'J OQQ I N ---COUNTY — Environmental Health Department N — Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date:2_IzylZmu� Inspector:S 1/1�i1MM1j/0h4W CONSTRUCTION Facility Address:_ Well Address: Total Depth: WP#?&12,G(o Well#:-( f ,SQ-2 Drilling Rig Type: Soil Boring#: SG?' ,6 -4� e�7_�i,S(�'�0 Min 2"Annular EHD Seal Verified: ❑ Yes El No Drilling Company: R)oc Cfl9,le �S(�• Driller Onsite: Screen Length From: To: Consultant: M ldhriicai denivi-kc, Filter Pack From: To: Geologist: 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 —aw, SAMPLING ABOVE-GROUND CHR*7Y-BOX COMPLETION Holding Temperature: COMPLETION Method: Grox,nd Sudace Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No �tt. tt. SPOILS tt = Contamination Noted: ❑ Yes ❑No = If yes, spoils storage Location: _ sbrtnd = � soon — Covered: ❑ Yes ❑No V-14 Pack If yes, material: =>x — I GROUTING or DESTRUCTION Total Depth: Depth to Water: - tt• — tt. Grout Material:— Neat MATERIALS/DEVELOPMENT Gallons of Grout Used: (r�'j�.� Casing Type: ❑Well Installation /*ell Destruction soh � Blank Feet Screen Feet tt/`"-' Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity XTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gall Bags pallons Bags Thickest Thinnest 9Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% MIX 5% 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 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.socehd.com