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ANJ �S 0A UIN •• Q Environmental Health Department Greatness grows here. Monitorin Well/Soil Boring Inspection Report Date: `, 110l,�Inspector: CONSTRUCTION Facility Address: X-N O`.N a Well Address: 0 1 Q Total Depth: WP# kA % Well#: _ Drilling Rig Type: Soil Boring#: '��f' ' Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: CaO-.�- lc�Q% Screen Length From: To: Driller Onsite: U. 14 V\• Filter Pack From: To: Consultant: k1CN r_ Geologist: 10 r,�rN Bentonite From: To: Grout From: To: Public Water System Onsite: jJ `� ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box Domestic Well Onsite: M 11� ❑ Yes ❑No casing If yes, location and distance: height SAMPLING ABov>:-61RoUND Holding Temperature: GbA�'t I:T}O[V COMP�LETiiON Method: Gnxind SWacs " Screening Method: proof 0/1 Verified Chain of Custody: ❑ Yes ❑No ft' ft. ts. SPOILS Contamination Noted: ❑ Yes ❑No a: If yes, spoils storage Location: slatted aacdon - rs --- Covered: ❑ Yes ❑No = Pack If yes, material: GROUTING or DESTRUCTION Total Depth:=='0W •. Depth to Water: \ n• ' Grout Material: Gallons of Grout Used: k:, /1� d MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation ❑Well Destruction Blank Feet Screen Feet Slot Size: El Boring Installation 0Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout []Over Drill Type/Brand of Bentonite: Filter Pack Type/Size: ❑ Gravity C�ITremie ❑Other: Type of Method: Water (Cement 47lb Water Cement 941b allons Bags Rallons Bags Thickest Thinnest gBags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 55% Mix 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 5 10 2 10 20 2 Bentonite per 94 lb 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 70 7 20 8 40 80 B 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