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SAJDAQUIN Environnnenta� Health Department —COUNTY— Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: I �bllfitio Inspector: CONSTRUCTION Facility Address: \1\ (0P,'-,UZk, 5 v, Well Address: Total Depth: WP# A- )A'I Well#: `' Drilling Rig Type: Soil Boring#: ' 'o �� Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: to Driller Onsite: �t.S� Screen Length From: To: SVCjQ.AJQ�PN Filter Pack From: To: Consultant: Geologist: Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes �lo COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: El Yes XNo casing If yes, location and distance: 9V height:. SAMPLING AWVE-dRcuND CChVLE K)N CHRM�-$ox Holding Temperature: cit LE-riota Method: �rt� � C%oundstria= f Screening Method: grout Verified Chain of Custody: ❑ Yes ❑No it. SPOILS ' Contamination Noted: ❑ Yes ❑No = _ If yes,spoils storage Location: - sec�on Covered: ❑ Yes ❑No _ _ g- Pack If yes, material: GROUTING or DESTRUCTION Total Depth:_ Depth to Water: Grout Material: Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet EJ Boring Installation Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity N\Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb Ilons Bas Ralf ons Bags Thickest Thinnest Bags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix 5%Mix 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 7_5 4 3 15 30 3 20 4 20 40 1 .s 25 5 25 50 s is 30 6 30 60 6 17,5 35 _7 35 70 7 20 40 8 40 1 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com