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�2 T. N -AN4JUMIN couNTv— Environmental Health Department Greatness grows here. Monitoring Well/Soil Boring Inspection Report Date: Insect or: CONSTRUCTION Facility Ad ress: �- Well Address: Total Depth: WP# Well#: Drilling Rig Type: Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No Drilling Company: (�J'4't F Driller Onsite: t4 Screen Length From: To: �� Filter Pack From: To: Consultant: com Geologist: F( 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 ABC)VE-GROUND CHRMii-Bo• Holding Temperature: C°& LEnon c-CWLETiorxr Method: C*Wnd Sud=' Screening Method: groud Verified Chain of Custody: ❑ Yes ❑Noft- ft. SPOILS Contamination Noted: ❑ Yes ❑No If yes,spoils storage Location: = c slottad Z71: Covered: ax9on �a = -3 Covered: ❑Yes ❑No graval1-X* If yes, material: p GROUTING or DESTRUCTION Total Depth: [qo . Depth to Water: l Grout Material: 0t'PL+ rt,v � Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation I*Nell Destruction Blank Feet Screen Feet Slot Size: ❑Boring Installation ❑Boring Destruction Bags of Cement: METHOD USED Bags Sand/Gravel: '91Type/Brand of Bentonite: Pressure Grout ❑Over Drill Filter Pack Type/Size: ❑ Gravity t�Tremie ❑Other: Type of Method: Water Cement 471b Water Cement 341b gallons Bags gaill ons Bags Thickest Thinnest gBags Thickest Thinnest tteags Bentonite/Cement Mix 3% Mix 5% MIX 2.5 5 1 5 18 1 Bentonite per 47 lb 1.41 2.47 s 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 715 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 1 35 7 35 70 7 20 1 40 8 40 80 8 2)bvj!yS LAI Ik 10/16/2017 �o L) -MCRA ev- 186$E. Hazelton Avenue I Stockton,California 95205 ( T 209 46&34201 F 209 4b4-513P) 1 www.sicehd.com