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S A N ) 0 AQ U I N Environmental Health Department -COU NTY--- Monitoring Well/Soil Boring Inspection Report Date: `� Z� Inspector: t��k_kr)cAjs CONSTRUCTION Facility Address: 0U'_+'jj WtOuuA Well Address: Total Depth: WP# ILk 0 Zc' Well#: Drilling Rig Type: Soil Boring#: B'R J33 Drilling Company: �, � Min 2" Annular EHD Seal Verified: El Yes ❑No Driller Onsite: Screen Length From: To: Consultant: (-616 r'% S Filter Pack From: To: Geologist: A 4 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 ABOVEGROUND C4_iRISTY-8OX Holding Temperature: COM?LETION COMPLETION Method: G=r)d S"rf"' Screening Method: grout ft Verified Chain of Custody: ❑ Yes ❑No - ft. ft. SPOILS — _ a Contamination Noted: ❑ Yes ❑No _ If yes, spoils storage Location: stood sac5on — � Covered: ❑ Yes ❑No = I ock If yes, material: _ GROUTING or DESTRUCTION Total Depth: a __ �{ ' ft. — Depth to Water: ft. r Grout Material: (? (1' 1°1� Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation ZBoring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity KTremie ❑Other: Type of Method: Water C ment 471b Water Cement 941b allons Bags gallons Bags Thickest Thinnest #Bags Thickest Thinnest 41Bags 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 4.7 715 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 60 6 }f Lk6_ 2I IL 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 1 F 209 464-0138 1 www.socehd.com