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r — C O U I\J T Y --- MonitorinJ,(-Q gVVell/Soil Boring Inspection Report Date: tz�v Inspectorr: PCL44 CONSTRUCTION Facility Address:_ a`('fh W JD VQ. Well Address: ��1q,,, Cq Total Depth: WP# 00 3 Well#: Drilling Rig Type: Soil Boring#: Drilling Company: 1� Min 2"Annular EHD Seal Verified: Yes ❑No Driller Onsite: 4�� Screen Length From: To: Consultant: i Filter Pack From: To: Geologist: Bentonite From: To: Qor Grout From: To: Public Water System Onsite: ❑ Yes E-1 No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casira If yes, location and distance: height SAMPLING ASoVE-ohout,o o - SAMPLING �F i i�Pd Gf•iRSTf-oox Holding Temperature: cc�t+rr.;sore Method: Screening Method: Verified Chain of Custody: ❑ Yes ❑No e fit. -�x --- t. SPOILS C Contamination Noted: ❑ Yes ❑No = If yes,spoils storage Location: _ ,srn� Covered: ❑ Yes ❑No If yes, material: _ GROUTING or DESTRUCTION Total Depth: - EE Depth to Water: �-- -if• <-- — (- Grout Material: MATERIALS/DEVELOP MENT Gallons of Grout Used: '• I -tl�� �4 Casing Type; ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation QrBSlot Size: oring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: 'Gravity ❑Trernie ❑Other: Type of Method: -Nater Cement 47 11) Water Cement 941b allons Bag's aalluns Baos Thickest Thinnest !Bads Thid;e:t Thinnest ^Bags B'erit:fir i telCement k i)C 3% �t�ix 55% Mix 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.4.1 2.47 5 10 2 10 20 7.5 1s 15 30 Bentonite per 94 Ib 2.82 4.,' 10 20 a 20 40 4 12.5 2J 5 25 50 5 V-[0, • }� .- �� 15 I 30 6 30 60 6 ��l�in �� O ✓ 1 ^�( �' �� rill r �J 170 35 7 7 20 an 40 35 ---,o e au 80 e 10/"16/2017 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 vvvvw.sicehd.com