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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 111 Yes ON° <br />To: <br />To: <br />To: <br />To: <br />COMPLETION El Stove Pipe <br />casing <br />height <br />DChristie Box <br />CHRISTY-BOX <br />COMPLETION <br />Ground Stews <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />( SANAOAQUIN tiltir-, ., ) COUNTY <br />c„,411.Ster / <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: qii(2,42..1 Inspector:kplit)',..s' to <br />Facility Address: <br />Well Address: 1O0 t,v 4i,, 1r1il cels-37,1, <br />wp# Co tit -0 3 <br />Soil Boring#: N--3 <br />Drilling Company:A:01 0 e- <br />V Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: Li Yes <br /> <br />ONo <br />Domestic Well Onsite: CI Yes El N o <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: CI Yes ONo <br />SPOILS <br />Contamination Noted: LI Yes ON° <br />If yes, spoils storage Location: <br />Covered: 111 Yes ONo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: Vii-1,1 <br />Gallons of Grout Used: <br />OWell Installation Li Well Destruction <br />OBoring Installation ABoring Destruction <br />METHOD USED <br />Pressure Grout DOver Drill <br />O Gravity E0ther: frte Alt <br />Water <br />gallons <br />Cement& <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest fl ags 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 25 50 5 <br />15 30 b 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 0 80 8 <br />CONSTRUCTION <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen <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 />10/16/2017 <br />SP( <br />g,V't f <br />Feet <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com