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S A N A 0 A Q U I N l 't , :1 —counlrv— Environmental Health Department Greatness grows here. 2 Monitoring Well/Soil Boring Inspection Report Date: Q r� 2 J Inspector: Saki rlas CONSTRUCTION Facility Address: 7S31�;Qrjeilr- LLno_ Well Address: Total Depth: WP## 0r) 1A.kg55 Well#: Drilling Rig Type: Soil Boring#: Min r Annular EHD Seal Verified: ❑Yes ❑No Drilling Compan� �YsE(Dhe Driller Onsite: EddiQ Screen Length From: To: Consultant: RaCLCII Filter Pack From: To: Geologist: 00molf 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 .' 47 SAMPLING i1Ep�r€ FiCt7N� CNRISTYOX Holding Temperature: COWLE ION noAtal>_nTigrl Method: 'f— Screening Method: ®rout Verified Chain of Custody: ❑Yes ❑Nolt• tt. SPOILS ft. Contamination Noted: ❑Yes ❑No ^ 7 0 If yes,spoils storage Location: Covered: ❑Yes ❑No sacacns W+VW pack if yes, material: — GROUTING-or-DESTRUCTION.Total Depth:---� -•- ..; ft. Depth to Water: L Grout Material: NQak&—OW IA L Gallons of Grout Used: MATERIALS/DEVELOPMENT Casing Type: ❑Well Installation 1RWell Destru ion Blank Feet Screen Feet ❑Boring Installation JZBoring Destruction Slot Size: Sb i % V a Po r probCS Bags of Cement: METHOD USED Bags Sand/Gravel: Type/Brand of Bentonite: ❑Pressure Grout ❑over Drill Fllter Pack Type/Size: XGravity ❑Tremie ❑Other: Type of Method: Water Cement 471 Water Cement041b allons Ba s allons Be Thickest Thinnes Bags Thickest I Thinnest #Bags Isentonitelcement Mix -3%MIX 5%MIX1. 25 s 1 s 1 10 1 1 Benfanite per 47lb 1.41 2A�7 5 10 2 10 20 2 Bentonite per 94lb 2.82 4.7 7.5 15 a 15 00 a Io 20 4 20 40 4 12.5 25 5 25 so 5 15 Be 6 30 fi0 6 17.6 as 7 35 70 7 20 40 0 40 e0 1 0 ' 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138.1 www.sicehd.com