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SQN1 o Q U I N Environmental Health Department vreotne,s gro vs here. Monitoring Well/Soil Boring Inspection Report Date:i wpL0 Inspector: `\. �(Xlem CONSTRUCTION Facility Address: C00%% ta%V p;r)e Gt. Well Address: Total Depth: WP#_Oar}03-�\ Well#: Drilling Rig Type: W% Soil Boring#: Q> Bk Min 2"Annular EHD Seal Ve`t�fied: El Yes El No Drilling Company: Ter!:=n Wel-0 Anc�ers►,n Driller Onsite: Chili 6 T*0 Screen Length From: To: Consultant:jtraCA)l)114;e1 -0 Ander6on 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: heIgnt SAMPLING ABOV£-61RDLIND CowL.ErIDN CORts1EMO Holding Temperature: cTioN Method: Screening Method: grout Verified Chain of Custody: ❑ Yes ❑Noft• ff. SPOILS _ Contamination Noted: ❑ Yes ❑No ~` If yes,spoils storage Location: ctomd stc�on s Covered: ❑ Yes []No �.'_' crnrat'Pzz'Ss If yes, material: w•• GROUTING or DESTRUCTION Total Depth: �k'5 Depth to Water: NOCN2 i r JL Grout Material: b>a} C-_nen-ir- MATERIALS/DEVELOPMENT Gallons of Grout Used: 2g5„p-- Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet ❑ Slot Size: Boring Installation Boring Destruction Bags Size: Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity XTremie ❑Other: Type of Method: Water Cement 47 lb Water Cement 94 lb gallons Bags gallons Bags Thickest Thinnest #Bags Thickest Thinnest #1 Bags Bentonite/Cement Mix 3%Mix 5% Mix 2.5 5 1 s 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 1s 3 15 30 .3 t 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 209 468-34201 F 209 464-0138 1 www.sicehd.com