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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes ON° <br />To: <br />To: <br />To: <br />To: <br />COMPLETION 0 Stove Pipe 0Christie Box <br /> <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />ASO' VT1--ROLIND <br />C0fr6LETION <br />casing <br />he.5_ght <br />COMPLETI9N1 <br />Grosind Surface <br />slatted <br />aerclan <br /> ft...T.— <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: OW a <br />Facility Address: "3e5ic <br />Well Address: <br />Inspector: L.", <br />q- <br /> <br />WP# 00 I—lei-32 Well#: <br />Soil Boring#: r>k, <br />Drilling Company: Are>. E <br />Driller Onsite: <br />Consultant: Prts-ril <br />Geologist: <br />Public Water System Onsite: .0 Yes 0No <br />Domestic Well Onsite: 0 Yes ENo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes E No <br />SPOILS <br />Contamination Noted: 0 Yes ONo <br />If yes, spoils storage Location: <br />Covered: 0 Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: (4,), <br />Depth to Water: 0 <br />Grout Material: (A.44.../C <br />Gallons of Grout Used: vip 5 <br />OWell Installation DWell Destruction <br />0Boring Installation 1111 cKing Destruction <br />METHOD USED <br />0Pressure Grout DOver Drill <br />11„,2fL•vity OTremie DOther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 94lb <br />Bags <br />Thickest Thinnest 4Bags 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 9 40 80 8 <br />CONSTRUCTION <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 />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com