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'l —COUNTY— Greatness � - v... ..v.....v....n. • .v..a.�.. wv�..w■ all•V IIL ! —COUNTY— . Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: O 1 Inspector: L,- >(, `' CONSTRUCTION Facility ddress: Z3 Z2-3 $ • A,&a�� ¢moi J Well Address: Total Depth: WP# (203n2,2_ Well#: Drilling Rig Type: Soil Boring-#: Z Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: �rw1 w� ` SSoe+e�cS :�s. Screen Length From: To: Driller Onsite: 1�rM1�t 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 ❑No casing If yes, location and distance: height SAMPLING ABOVE-GFICUND Holding Temperature: CO F°N rC.0 P1=10N Method: tmvnd SLuirs Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No � rt_ SPOILS Contamination Noted: ❑ Yes El No If yes, spoils storage Location: ssc�cn Covered: ElYes ❑No If yes, material: = '- _a GROUTING or DESTRUCTION Total Depth: ��'[>✓ Depth to Water: 4*4 Grout Material: 1/Nts4- lty-1«A MATERIALS/DEVELOPMENT Gallons of Grout Used:— Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation [4�ring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity Vrremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb goal] ns Bags 221111 s Bags Thickest Thinnest 9Bags Thickest Thinnest riBags BentoniteXement 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 lb 2.82 4.7 7.5 15 3 15 30 3 10 20 4 20 40 4 125 25 5 25 50 5 Arm J 15 30 30 1 5 5 1,-,A> y, (y 1Z5 35 7 7 35 70 70 7 7 �L 1 _J 20 40 B 40 00 e Zo� tj z v�- `1 L4 bb 1.0/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T' 209 468-34201 IF 209 464-0138 1 www.sicehd.com