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COMPLETION LI Stove Pipe <br />casing <br />height <br />LIChristie Box <br />clismry.aox <br />COWLS-19N <br />SANAAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: \% Inspector:Q- <br />Facility Address: 1.:1A? . C-N.NN4-54-\ <br />Well Address: 1,.k.kjN,NQ <br />WP# `-\\.\Q Well#: <br />Soil Boring#: <br />Drilling Company: N) \r3 <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: <br /> fl Yes ljNo <br />Domestic Well Onsite: Yes 0No <br />If yes, location and distance: <br /> <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: <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: j4 v <br />Gallons of Grout Used: (N-K) ck <br />1=IWell Installation IDWell Destruction <br />OBoring Installation DBoring Destruction <br />METHOD USED <br />El Pressure Grout lilOver Drill <br />El Gravity <br /> <br />V7Tremie <br />Water <br />gallons <br />Cement 47Ih <br />Bags <br />Water <br />gallons <br />Cement 94Ib <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 e <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: CI Yes ON° <br />To: <br />To: <br />To: <br />To: <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 />Filter Pack Type/Size: <br />Type of 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 />El Yes ON° <br />El Yes ,No <br />Yes LjA No <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout From: <br />(-;4, AJZ) \ <br />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />10/16/2017