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SANAAWN Environmental Health Department COUNTY— ' Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Inspector: &11LACL& CONSTRUCTION Facility Address: r ah7�Co. Well Address: _ Total Depth: WP# ID6 b W II#: Drilling Rig Type: Soil Boring#: �Zr Cn Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: ?.i O/✓y Screen Length From: To: Filter Pack From: To: Consultant: 610 Geologist: rte,, 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 AW VE.�3ROUNp W. -:p Holding Temperature: CowLN COWLEriON ETio Method: cr°""as"f"' Screening Method: Oran Verified Chain of Custody: ❑ Yes ❑No .4r —ft- SPOILS =_ Contamination Noted: ❑Yes ❑No If yes,spoils storage Location: slotad == soon 3 Covered: ❑ Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth:_ IFr Depth to Water: Grout Material: N Q.e1 r(I U�1Jv� MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ' Slot Size: ❑Boring Installation�Bonng Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: Vressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity 'rkremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bags goalions Bags Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 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 0 8 40 80 8 10/16/2017 1368 E. Hazelton Avenue E Stockton, California 952.05 � 7 209468-34201 F 209464-G133 I www.sicehd.com