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"'. _, SANJOA UIN YT Q Environmental Health Department <br /> F <br /> —COUNTY— <br /> Greatness 9lO V/S IIPlP. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 1►\ CONSTRUCTION <br /> Facility A dress: 2 b. 1ji4i a, <br /> Well Address: Total Depth: 1 I)g <br /> WP# 0 Ntt 8 52 / Well#: Drilling Rig Type: oil <br /> Soil Boring#: VA.W \ r1 Min 2"Annular EHD Seal Verified: El Yes El No <br /> Drilling Company: t%Z'7' 1 'EN Vz RotJFA M JTA L <br /> Driller Onsite: 2 Screen Length From:9s To: <br /> Consultant: Cn'1 ,Yo111 ArL4 63nfve qii`F <br /> ilter Pack Fromif To: <br /> Geologist: "Bentonite From: To: g8• <br /> Grout From: Bg.S To: 5�ffac <br /> Public Water System Onsite: ❑Yes []No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: � height <br /> SAMPLING ABOVE-GROUND <br /> COLPLEION CHa151Y-BOX <br /> Holding Temperature: coMriEnoN <br /> Method: G=ndSul>ca <br /> Screening Method: g(CIA <br /> Verified Chain of Custody: ❑ Yes ❑No s--h <br /> H. <br /> SPOILS �tt• <br /> — q <br /> Contamination Noted: El Yes []No !!! —• <br /> If yes,spoils storage Location: <br /> o <br /> atotsad �,7A <br /> section B <br /> Covered: ❑ Yes ❑No <br /> — a+w+pxx <br /> If yes, material: `k <br /> GROUTING or DESTRUCTION Total Depth: 11 <br /> Depth to Water: 1 11 N• — t1• <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: 'A,V 4) UA <br /> IR[Well Installation ❑Well Destruction S51` Blank _Feet V Screen Feet <br /> El Boring Installation ❑Boring Destruction ] r}I of Size: <br /> �5� \ h 0 ags of Cement: 2 <br /> METHOD USED IInni1 �p1rf- Bags Sand/Gravel: <br /> ❑Pressure Grout Dover Drill OType/Brand of Bentonite: <br /> ALj aFilter Pack Type/Size: A!`!5 <br /> El Gravity ❑Tremie ❑other v'J t0t'ype of Method: GQ!^2wyp "%4'. <br /> Water ment 471b Water Cement941b <br /> allons Sasts zallons Bags <br /> Thickest Thinnest g1 Thickest Thinnest #Balls Bentonite/Cennent Mix 3% Mil 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite er47lb 7.4 2.47 <br /> 5 1042310202 Bentonite er 94lb 2.82 4. <br /> 7.5 1515 30310 2020 40 4 <br /> 12.5 2525 50 5 <br /> 15 3030 60 6 <br /> 17.5 3535 70 7 <br /> 20 1 40 B 40 00 B <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />