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A <br />COMPLETION El Stove Pipe DChristie Box <br />casing <br />height <br />ABOVE-GROUND <br />COMPLETION CHRISTY-BOX - <br />COMPLETION <br /> Ground Suttees <br />grout <br />It. <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />El Yes EINo <br />To: <br />To: <br />To: <br />To: <br />From: <br />From: <br />From: <br />From: <br />slotted <br />Jr <br />secdon <br />gravelpodt <br />IL <br /> SANAOAQUIN <br />Nor COUNTY <br />.4,4L:T.,5,v,•,, <br />• <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:) 7c1 j <br />Facility Address: <br />Well Address: Ugc,I Wk k titS(,c (4 \ <br />WP# (C,‘ t4 11 3g Well#: <br />Soil Boring#: <br />Drilling Company: iiire,7 ,t ,n 4ASJ06''c..k.K ie <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: Yes El No <br />Domestic Well Onsite: LI Yes Ell\lo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes ON° <br />SPOILS <br />Contamination Noted: El Yes El No <br />If yes, spoils storage Location: <br />Covered: LlYes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: gkr 1 <br />Depth to Water: <br />Grout Material: frfot. <br />Gallons of Grout Used: <br />111 Well Installation LI Well Destruction <br />Eli Boring Installation [Boring Destruction <br />METHOD USED <br />OPressure Grout DOver Drill <br />LI Gravity igTremie ElOther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest 4 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 />Total Depth: <br />Drilling Rig Type: <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 />10/16/2017 <br />Inspector: firct,,f,'S IC41 CONSTRUCTION <br />14,4 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com