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JA IV .1 UAV U I IV Environmental Health Department COUNTY— "- Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: I'le'sch IInspector: I �� CONSTRUCTION Facility Address: 'Zoo &jb, e# Well Address: J Total Depth: WP# q4ft 0u3gmii Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: Driller Onsite: r Screen Length From: To: Consultant: �} � Filter Pack From: To: Geologist: � j r,,,�; 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: haight SAMPLING ABOVE�IaCUND Holding Temperature: i0.. LETION � orr 1�fF' a Method: Gnwnd Surf Screening Method: of Verified Chain of Custody: ❑ Yes ❑No �- ft. ft. SPOILS = 79 , Contamination Noted: ❑ Yes ❑No = o If yes, spoils storage Location: Covered: ❑Yes ❑No If yes, material: GROUTING or DESTRUCTION Total Depth: ♦ — Depth to Water: Grout Material: f e— C&*~,wAr— MATERIALS/DEVELOPMENT Gallons of Grout Used: Casing Type: []Well Installation U ell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags iz Cement: METHOD USED Bags Sand/Gravel: 3411'*essure Grout ❑Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity ❑Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 941b Ilons Bas Fallons Bags Thickest Thinnest 4Bags Thickest Thinnest #Bags 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 Ib 2.82 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 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T' 209 468-34201 IF 209 464-0138 www.sicehd.com