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!'—' �,' —COUNTY— P-'-- -- -------•_-Il- "- - Greatness grams here. Mom- ging Well/Soil Boring Inspectic. Report Date: LH Inspector: L4V CONSTRUCTION T Facility Address: Well Address: Fsk, 4- (Ylc� v Total Depth: WP#-C�X2 714 8-S Well : ��'Gb4 Drilling Rig Type: Soil Boring#: fiouZ ,-, IP ol ( 1/157h-) Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: C7-y&< c>,- Driller Onsite: alp.4 Q.v1Ci �— Screen Length From: To:— Consultant:— o:Consultant: Filter Pack From: To: Geologist: �jz„ �,��t Bentonite From: To: Grout From: To: Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: ❑ Yes ❑No If yes, location and distance: Height SAMPLING ABOVE-GROUND Holding Temperature: COWLETzQN G P`oN Method: C=rud Strfra Screening Method: Qrt Verified Chain of Custody: ❑ Yes ❑No SPOILS _ TF�- Contamination Noted: ❑ Yes ❑No = If yes, spoils storage Location: Covered: ❑ Yes ❑No _ - EE r If yes, material: EH GROUTING or DESTRUCTION Total Depth: 33 Depth to Water: Z4!6. Grout Material: fy-Ar MATERIALS/DEVELOPMENT Gallons of Grout Used:-k-op Casing Type: ❑Well Installation EjVell Destruction Blank Feet Screen Feet ❑Boring Installation ❑Boring Destruction Slot Size: Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ver Drill Filter Pack Type/Size: U? ravity envie ❑Other: Type of Method: Water Cement 471b Water Cement 94 lb Ilons Bas Lallons Bags Thickest Thinnest 4Bags Thickest Thinnest PBags Bentonite/Cement Mix 3% Mix 5% Mix 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 5 1D• z 10 20 2 Bentonite per 941b 2.82 4.7 7.5 15 3 15 30 3 10 20 4 20 40 4 , 1C.1 12.5 25 5 25 50 5 ! .� fl�S _S .��1j✓.� b� 15 30 6 30 1 so 6 17.5 35 7 35 1 70 7 1 zo 40 a 40 aD a r� o- G�1�►-cA�� `b •� U 10/16/2017 1868 E. Hazelton Avenue Stockton, California 95205 I T' 209468-34201 F 2D9464-0138 I www.sicehd.com C-10 PZov