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` WOUAQUIN Environmental Health Department —COUNTY— ` ` fir^ ; • t�_� `• Greatness grows here. �1 Moni't/o�^rIi'ng/'-Well/Soil Boring Inspection Report Date: l lU Inspector: a�,N�/'Ur e CONSTRUCTION Facility Address. $ W MiwW+UA Well Address:/� Total Depth: WP# n n� I �1 V 52 Well#: Drilling Rig Type: Soil Boring#: 421 % Min 2"Annular EHD Seal Verified: ElYes ❑No Drilling Company: &Vel I Driller Onsite: Screen Length From: To: Consultant:_ QX Filter Pack From: To: Geologist: 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 AWVE-GROUND • Holding Temperature: COw� c 1°N —ot LEFTiON Method: Croond Sufacu Screening Method: grout Verified Chain of Custody: ❑ Yes ❑Noft- ft. SPOILS Contamination Noted: ❑ Yes ❑No = = o If yes,spoils storage Location: stormed r: sac5on _ Covered: ❑ Yes ❑No } g-vw Pack If yes, material: GROUTING or DESTRUCTION Total Depth:20�� • _ Depth to Water: —" ft. = ft Grout Material: 't'3 0 nt cle rM yk. MATERIALS/DEVELOPMENT Gallons of Grout Used: 3r3 qVAM a-CL -) �7�� Casing Type: ❑Well Installation 'Nell Destru on Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 34 lb allons Bags gaill ons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 55%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 lb 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 40 80 8 10/16/2017 1888 E. Hazelton Avenue I Stockton,Ca6fa-nia 95205 7 209 468-34201 F 209 464-0138 1 www.sicehd.com