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S A N 10 AQ U I N Environmental Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: 7 Inspector: &j1�` '"i CONSTRUCTION Facility Address: kX5 ,V, '.4 :j' e_ Total Depth: 45=k U A Well Address: WP# ff-) 'q,75— �� ,�' Drilling Rig Type: Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Ae Screen Length From: /`l'f 'To: Driller Onsite: Ci Filter Pack From: l�� To: 'J3•� t Geologist: �F'�U�`i/'� Bentonite From: +S To:�`�� Consultant: Grout From: - l To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box �/��,l Domestic Well Onsite: ❑ Yes ❑No casing J {�-?" �J2°�j If yes, location and distance: T height ( 13T F6 —kw-F "II SAMPLING ABOVE-GROUND CHM -Box Holding Temperature: COMPLETION COMPLETION Method: Ground surix• Screening Method: oil groutS n. Verified Chain of Custody: ❑ Yes ❑No ft. SPOILS = a Contamination Noted: ❑ ❑No Yes � = m 4 If yes, spoils storage Location: , stonad sac�on Covered: El Yes ❑Nogr,vM pack If yes, material: EE GROUTING or DESTRUCTION Total Depth: Depth to Water: Grout Material: ee MATERIALS/DEVELOPMENT Gallons of Grout Used: 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 Cement 471b Water Cement 941b allons Bags gallons Bags Thickest Thinnest NBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix z.s s 1 s 10 1 Bentonite per 47 lb 1.41 2.47 s 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 j 1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com