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COUNTY Z. -- Greatness grams here. Mon,,-ring Well/Soil Boring Inspecti(-.. Report Date: Inspector: Lo, )(03 CONSTRUCTION Facility Address: I b7-71 (2.a — Well Address: 1.1,= M-� �c;.w+ " Total Depth: WP# W 3 :7:7 Well#: t w- �J, Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: e I�b.,,, :L4 Driller Onsite: Screen Length From: To: Consultant: Filter Pack From: To: Geologist: �c,e Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes []No c=sing If yes, location and distance: b=ight SAMPLING VEE-GROUND Holding Temperature: COWLETFON ct ap o Method: oravndsurr ,�" Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No fL ii. tt. SPOILS - Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Covered: ❑Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: —_ Depth to Water: Grout Material: I'Lth MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation El Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity IN?remie ❑Other: Type of Method: Water Cement 471b Water Cement 941b gallons Bas Rallons Baes Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 5 10' 2 10 20 2 Bentonite per 941b 2.82 4.f 7,5 15 3 15 30 3 I I i i 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 60 6 v 17.5 35 7 35 70 7 20 40 0 40 Be— 8 10/16/2017 1868 E. Hazelton Avenue J Stockton, California 95205 J T' 209 468-34201 IF 209 464-0138 J www.sicehd.com