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: SAS ° OAQUEN Environmental Health Department .C.O U N T Y— Greatness grows here. lq Monitoring Well/Soil Boring Inspection Report `f Date: aD Inspector: N3 " CONSTRUCTION Facility Address: k1533 Well Address: Total Depth: WP# �L `.p�� Well#: Drilling Rig Type: Soil Boring#: I '' S Min�jlnnylar EFID Seal Verified: ❑ Yes ❑No Drilling Company: ti�1�` _ L�\,c�t- yJLLWC Driller Onsite: fi�.3Ykk3 Screen LengthFrom: To: Q 4b kk—- Filter Pack From: To: Consultant: MCS S�C- 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: R height SAMPLING Holding Temperature: co `' TioN c*WLEriON Method: QfO""�$ �' + Screening Method: e� Verified Chain of Custody: ❑ Yes ❑No _ft_ SPOILS Contamination Noted: ❑ Yes f No If yes,spoils storage Location: atottad a s2c5on — -° Covered: ❑ Yes []No ': gavot pact If yes, material: GROUTING or DESTRUCTION Total Depth: •Lj) Depth to Water: N f ft' Grout Material: N R Z' C MATERIALS/DEVELOPMENT Gallons of Grout Used:G 11) °l CA - Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation kBoring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity Tremie ❑Other: Type of Method: Water I Cement 471b Water Cement 941b Vons Bas Raill ons Bags Thickest Thinnest Bags Thickest Thinnest #Bags Sentonite/Cement Mise 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 7.5 15 3 15 30 3 i 10 20 4 20 40 4 12.5 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 1 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 IF 209 464-0138 1 www.sicehd.com