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_�WOUAWNEnvironmental Health Department COUNTY— ,� i Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: t2' I$ Inspector: V h CONSTRUCTION Facility Address:_—A 3j Mt)ff Mt 9W)V _lwfie C.a- Well Address: �— Total Depth: WP#_ tt fj - 1C)? 2- Weil#: Drilling Rig Type: Soil Boring#: � Min 2"Annular EHD Seal Verified: ❑ Yes nNo Drilling Company: yFEW Pa-Iw4m Driller Onsite: 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 ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No casing If yes, location and distance: height i SAMPLING , SOVE-Gaaltan - - CHR Holding Temperature: °OwLEr}ON CQWLETiON Method: G"Und sviaas Screening Method: n� Verified Chain of Custody: ❑ Yes ❑No f' ft. ft. SPOILS X. Contamination Noted: ❑ Yes ❑No = o If yes,spoils storage Location: stormed aan } Covered: ❑ Yes ❑No g-val Pack If yes, material: GROUTING or DESTRUCTION Total Depth:9l%$1F7 1S2=12FT �- = Depth to Water: n- IF ' Grout Material: Ne'O' " e Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation Loring 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 941b gallons Bags gall ons Bags Thickest Thinnest #Bags Thickest Thinnest #Bags BentonitelCement Mix 3% Mix 5%Mix 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 5 10 0 10 20 2 Bentonite per 94 lb 2.82 4.7 7.5 15 3 15 30 3 10 20 4 40 12,5 25 5 25 s0 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 .1941dio,2 R 3=2x 1 ws uw4 ,` 4- 10/16/2017 1388 E. Hazelton Avenue 1 Stockton,California 95205 1 T 20946&34201 F 209464-0138 1 www.sicehd.com