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Domestic Well Onsite: <br /> 0 Yes 0 N o <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />casing <br />height <br />CHRMTY-80X <br />COMPLETION <br />Ground Strfacs <br />.— <br />ABOVEGROUND <br />COMPLETION <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest St 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 a e ao 80 8 <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 />6,) ( <br /> <br />10/16/2017 <br />SANAOAQUIN <br />COUNTY <br />Greatness yrovs here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: -q 1 7(7r z j Inspector: 1(•--; , CONSTRUCTION <br /> <br />Facility Address: <br />Well Address: <br />WP# We11#: <br />Soil Boring#: Q3 -\ <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: CI Yes LINo <br />To: <br />To: <br />To: <br />To: <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />Public Water System Onsite: 0 Yes El N o COMPLETION 0 Stove Pipe 0Christie Box <br /> <br />Screening Method: <br />Verified Chain of Custody: <br /> <br />0 Yes 0 N o <br />SPOILS <br />Contamination Noted: 0 Yes El No <br />If yes, spoils storage Location: <br />Covered: 0 Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />0 Well Installation El Well Destruction <br />0Boring Installation EBoring Destruction <br />METHOD USED <br />IIIPressure Grout DOver Drill <br />0 Gravity V]Tremie 00ther: <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 />Feet <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com