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c as ing f height <br />ABOVE-GROUND <br />COMPLETION <br />— criaj'IT <br />N <br />cailsri4ox • <br />COMPLETIpN <br />Environment leaith Department <br />Greotness grows bore. <br />Monitoring Weil/Soil Boring Inspection Report <br />Date: TA / Inspector: <br />Facility Address: S-IK- w <br />Well Address: <br />WP# 003 -lerki <br />Soil Boring#: <br />Drilling Company: Are, <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: 0 Yes ON° <br />Domestic Well Onsite: 0 Yes ON° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes ONo <br />SPOILS <br />Contamination Noted: 0 Yes 0 No <br />If yes, spoils storage Location: <br />Covered: 0 Yes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />.III Well Installation OWell Destruction <br />OBoring Installation OBoring Destruction <br />METHOD USED <br />OPressure Grout 00ver Drill <br />0 Gravity" OTremie 00ther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thtckest Thinnest # Bags Thickest Thinnest I/ Bags <br />25 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 5 <br />17,5 35 7 35 70 7 <br />20 40 8 40 So 8 <br />CONSTRUCTION • <br />Total Depth: (..z efr <br />Drilling Rig Type: tuitm. rm.-I-- <br />Min 2" Annular EHD Seal Verified: l2f/Yes ON° <br />Screen Length From: X. C To: <br />Filter Pack From: 4.1 To: S <br />Bentonite From:__S-- To: ..r" <br />Grout From: '1 -s" To: ,Swe c.c.s <br />COMPLETION 0 Stove Pipe Egt-h-el:istie Box <br />MATERIALS/DEVELOPMENT <br />Casing Type: T pu, <br />Blank 4,•_5" Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: ‘1114.54... <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 />Went: Sy I jcvi_ <br />Screen I ',AA. Feet <br />10/16/2017 <br />1868 E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 F 209 464-0138 I www.sIcehd.com