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SAI0UM rear l-ire mt y f �eafth Depart ieni: C O U N TY— :Fraa^'• Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date:1�f 2t I►Q Inspector: i). Saeyern CONSTRUCTION Facility Address:2,5644 ?�QrOrr F-a. Well Address: Total Depth: WP# Well#: Drilling Rig Type: 1314 Soil Boring#: oA CPT 103 GPT Drilling Company: G!, P90 1�r1'11"0q Min 2"Annular EHD Seal Vel-�fied: ❑Yes El No Driller Onsite:C-1p nan E Tnrne Screen Length From: To: Consultant: K1C'�OQ\Ae,r Filter Pack From: To: Geologist: \yfo 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 SAMPLINGyA � Holding Temperature: cotL rioN c# tsrY sox coTioN Method: - Grvindsu-ta Screening Method: grout Verified Chain of Custody: ❑Yes ❑No n tt. SPOILS — Contamination Noted: ❑Yes ❑No = = If yes,spoils storage Location: ataitna s v:. Covered: ❑ Yes ❑No � . If yes, material: Q :x =•• GROUTING or DESTRUCTION Total Depth: l�� <= 50' A Depth to Water: 3a' 42� P, - Grout Material:N_ C MN* MATERIALS/DEVELOPMENT Gallons of Grout Used: I_+ gal • Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation l Boring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity gTremie ❑Other: Type of Method: Water Cement 47 lb Water Cement 94 lb gallons Bas gallons Bags Thickest Thinnest #Bags Thickest Thinnest nBags Bentonite/Cement Mise 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 75 1 15 r 3 15 1 30 1 3 10 1 20 420 1 40 1 4 12.5 25 525 50 5 15 30 630 60 5 17.5 35 735 70 7 20 40 8d— 4.0 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com