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JANAWIN Environmental Health Department iz �?• �p ronmeneap 1.47 Greatness grows here. oq Monitoring Well/Soil Boring Inspection Report Date: Inspector: f1XV-kAT6L( CONSTRUCTION Facility A dress: 30100Loauh mv\kca.. Well Address: Total Depth: WP# 003 '601S-t) Well#: Drilling Rig Type: Soil Boring#: 2 P— 116 O 2' Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: l&O. VJ 1�j Screen Length From: To: Consultant: Filter Pack From: To: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: —fF=l=]f height SAMPLING ABOVE-GROUND - C Holding Temperature: cowLEmn MP�OLETiON Method: cx«snasurtxa +_ Screening Method: grow Verified Chain of Custody: ❑ Yes ❑Noft. fi. ft. SPOILS r Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: 7 sacyon } Covered: ❑ Yes ❑No — i-vvip--k If yes, material: GROUTING or DESTRUCTION Total Depth: S7 Ct7' ,`b Ft- • Depth to Water: w— M * ' Grout Material: C,cAM44AF MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ell Destruction Blank Feet Screen Feet Slot Size: ❑Boring InstallationA 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 Mons q0a Ilons Bags Thickest Thinnest *Bags Thickest Thinnest #Bags BentonitefCement 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 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 (J 20 40 8 40 80 8 J 1388 E. Hazelton Avenue I Stockton,Calfamia 95205 I T 209 468-3420 1 F 209 464--0138 1 www.sicehd.com