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SANo,10AQUIN Environmental Health Department Greatness grows fere. Monitoring Well/Soil Boring Inspection Report Date: h Inspector: lit 5" (X1 CQNSTRUCTION Facility Address: I Well Ads: — Total Depth: WP# dreU O>; Well#: Drilling Rig Type: Soil Boring#: Drilling Company: Min 2" Annular EHD Seal Verified: 11 Yes []No Driller Onsite: Screen Length From: To: Consultant: `�C'(;��CtiCU �^ Filter Pack From: To: Geologist: Ale-,'I LI/Sy"- 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-GROUND Holding Temperature: COWPLETION cccmPPLEnooN Met hod: Ground Surface Screening Method: arm Verified Chain of Custody: ❑ Yes El No �tt. ft. —ft. SPOILS _ Contamination Noted: ❑ Yes ❑No ;= If yes,spoils storage Location: slotted _ - saczon = Covered: ❑ Yes El No If yes, material: GROUTING or DESTRUCTION Total Depth:y )< IF Depth to Water: IVJ '4 e- �% �^�Oi.�^ Vewl- Grout Material: Ro-Se 1 -FW e- MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet El Boring Installation. BSlot Size: oring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: Gravity OTremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b allons Bas allons Bags Tilicke5t lkline,t 9Bags Tl-ickest Ti)inne;t „Bags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 5 10 2 10 20 2 Bentonite per 94 Ib 1 2.821 4.7 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 50 5 15 30 6 30 1 60 6 17.5 35 7 35 1 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