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casing <br />height <br />ci-nmr6box <br />COMPLETI9N <br />I ^ y <br />.3C11 SANAOAQUIN Environmei 1 Health Department COUNTY <br />Greatness grows here. <br />/6 <br />Date: Inspector: <br />Facility Address:/4 6 7 1' <br />Well Address: S, <br />p OD 3 7 -70 Well#: <br />Soil Boring#: <br />Drilling Company: eAA,4_ <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes ONo <br />To: <br />To: <br />To: <br />To: <br />Monitoring Well/Soil Boring Inspection Report <br /> <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />Or^ IJMr <br />Public Water System Onsite: Yes ClNo <br />COMPLETION I=1 Stove Pipe OChristie Box <br />Domestic Well Onsite: Yes EINo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: LlYes LIN° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 4_57 <br />sfl,1 p. <br />LIII Well Installation LIWe D structi n , <br />OBoring Installation IDBoring Detructior <br />METHOD USED <br />EPressure Grout ElOver Dr' <br />[i] Gravity Trem <br />Water <br />gallons <br />cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest "ags <br />2.5 5 1 5 10 1 <br />s lo 2 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 40 4 <br />12.5 25 5 25 50 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br /> <br />iter ack Type/Size: <br />61) f Method: <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />I=1 Yes ON° <br />Yes EINo <br />Grout Material: <br />Gallons of Grout <br />Z-5b <br />Used: <br />10/16/2017 <br />1868 E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 1, www.sicehd.com