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ANJOAQUIN Envi[ronmentai H0iv.fth Department —C.OU NTY— Greatness crows here. Monitoring Well/Soil Boring Inspection Report Date:.t Ll-JA& Inspector: N >- CONSTRUCTION Facility Address: g* Well Address: S. !b�,o . �•. Total Depth: WP# Ob Well#: L t "L Drilling Rig Type: Soil Boring#: 1- 3!N \-C 3 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: J�IhWLb Driller Onsite; Screen Length From: To: ��` Filter Pack From: To: Consultant: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes �No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes kN0 casing If yes, location and distance: height T 4SAMPLING ABOVE-GROUND - C�HR Holding Temperature: COMPLr_rnN cot�pL rioisi Method: c,�,r a spa A Screening Method: growl Verified Chain of Custody: ❑ Yes ❑No —�-p— ' SPOILS a Contamination Noted: ❑ Yes ❑No ` le If yes,spoils storage Location: Covered: ❑ Yes El No Pack If yes, material: GROUTING or DESTRUCTION Total Depth: Depth to Water: ��` ft. Grout Material:—�Y: C�tC MATERIALS/DEVELOPMENT Gallons of Grout Used: \CA _ Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑Boring Installation Noring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: []PressureGrout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity *Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb allons Bas Rail ons Bags Thickest Thinnest Bags Thickest Thinnest Bags Bentonite/Cement 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 �7,2 15 3 15 30 a 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 8 40 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