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COMPLETION LI Stove Pipe <br />casing IT height 11 <br />ElPressure Grout DOver Drill <br />ID Gravity r<rnie 1110ther: <br /> SANIJUI AOUIN tttt. t it't <br />COUNTY— Environmental Health Department <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Co0/2„7//i Inspector: i-doe Xi • 'D <br />Facility Address: -0:11 1-1,14•S tAJ <br />Well Address: <br />WP# 0,931N -v-t Well#: AA vJ 40 <br />Soil Boring#: 43 w‘o ti, 6'13 —8 <br />Drilling Company: <br />Driller Onsite: ao-v-r,4.1 <br />Consultant: 64,44, <br />Geologist: v•-c, <br />Public Water System Onsite: D Yes ENo <br />Domestic Well Onsite: LI Yes DNo <br />If yes, location and distance: <br />CONSTRUCTION <br />Total Depth: 25% <br />Drilling Rig Type: )4 016,..) <br />Min 2" Annular EHD Seal Verified: D Yes ENo <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: ,5 To: <br />From: S To: <br />From:_216-weil o <br />From: 0 To: <br />Zes" <br />3._C <br />A 7, tc- <br />Rfhristi e Box <br />,46,8 <br />s„ AIM 4 <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: D Yes ENo <br />SPOILS <br />Contamination Noted: D Yes 111No <br />If yes, spoils storage Location: <br />Covered: EYes ENo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: jvr <br />Depth to Water: tz ft <br />Grout Material: fv44.-1- <br />Gallons of Grout Used: ay 115 <br />elI Installation EWell Destruction <br />Li Boring Installation Ii<r-ing Destruction <br />METHOD USED <br />ABOVE-GROUND <br />COMPLETION <br />MATERIALS/DEVELOPMENT <br /> <br />Blank <br />- <br />Blank Feet <br />Slot Size: .010 <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Casing Type: <br />OH:FUSTY-BOX <br />COMPLETION <br />Screen Zd Feet <br />Type/Brand of Bentonite: , 2 c._1",o ce4—c,0 <br />Filter Pack Type/Size: <br />Type of Method: <br />Water <br />gallons <br />Cement 47!b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # Bags <br />2.5 5 1 5 10 1 <br />5 10 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 />BentonitelCement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />1368 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 I F 209 464-0138 I www.sicehd.com