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$:':--�=, 3AN-JUAQUII4 Environmental Health Department —COUNTY— Greotness groes here. Monitoring Well/Soil Boring Inspection Report Date: tki1 Inspector: CONSTRUCTION Facility Address:JA -177 Well Address: 12* Total Depth: _ WP# "VR31ox I e11#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: VYes ❑No Drilling Company: �ei1��..� 7�, Screen Length From: 'L'i 3 To: 2 5 3 Driller Onsite: ,�nye.. Filter Pack From: x-33 To: 2(ad Consultant: L�;�� c_ Bentonite From:Z.."z5 To: ---',� Geologist:_ �h Grout From: C2 To: -?-iA Public Water System Onsite: ❑ Yes ❑No COMPLETION 2-5-ove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No If yes, location and distance: I heiglit ; SAMPLING ABOVE-6ROUND coil=rFOH r�Isry-sox Holding Temperature: ccuPLEETiom Method: Gmind Susixy Screening Method: erg Verified Chain of Custody: ❑ Yes ❑No f' ft. ft- SPOILS = Contamination Noted: ❑ Yes ❑No — o If yes, spoils storage Location: Covered: ❑Yes ❑No = � If yes, material: _- GROUTING or DESTRUCTION Total Depth:Lly� _ Depth to Water: Grout Material: Gallons ENT of Grout Used: Casing Type: f'�� gess -Fr--4 j NIK�ell Installation ❑Well Destruction Blank 1W"N3 Feet Screen Feet Slot Size: .¢7,p ❑Boring Installation El Boring Destruction gags iz Cement: METHOD USED Bags Sand/Gravel: 1't�3. , iS bis ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite:2 JV Filter Pack Type/Size: ❑ Gravityremie ❑Other: Type of Method: Water cement 471b Water Cement 941b gallons Bas gall ons Bags Thickest Thinnest 4Bags Thickest Thinnest 9Bags 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 lb 2.82 4.7 7.5 15 3 15 30 3 i 10 20 4 20 40 9 12.5 25 5 25 50 5 �G 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 �,W 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 1 T' 209 468-34201 F 209 464-0138 i www.sicehd.com !S