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Well: 6 ig-1 Drilling Rig Type: <br />,0A/voY__ <br />3(-1--A) <br />Soil Boring#: <br />Drilling Company: VV 'J <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />D Yes 111No Verified Chain of Custody: <br />SPOILS <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 17-i (at r1 Inspector: A CONSTRUCTION <br />Facility Address: Fic) (-41-2r,---C--1-6, <br />Well Address: Address: <br />wptt no / <br />de <br />Total Depth: 4-77 <br />ID Yes 'atNo <br />Yes 41,No <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: LI Yes LII No <br />If yes, spoils storage Location: <br />Covered: El Yes El N o <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />LII Well Installation OWell Destruction <br />D Boring Installation CI Boring Destruction <br />METHOD USED <br />LllPressure Grout DOver Drill <br />El Gravity DTremie DOther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest # 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 a <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 />1;0-911C <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 <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: Lk( <br />From: <br />From: -7.7ol <br />From: <br />CI Stove Pipe <br />Yes ElNo <br />To: 4-127' <br />To: 4-3 <br />To: 3 <br />To: <br />,Christie Box <br />Min 2" Annular EHD Seal Verified: <br />casing <br />height <br />CHIRMY-8.410X <br />CORAFtEn9N <br />MATERIALS/DEVELOPMENT ,t <br />Casing Type: <br />Blank “-T Feet Screen 1-1 Feet <br />Slot Size: -Prrct/W, <br />Bags of Cement: 2- f76,5 6,,e1g0A/ 8z-ciAtt urcl? <br />Bags Sand/&: Z <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />• <br />grows here. Greatness <br />SAN JOAQUIN .; 1-itrk.." COUNTY <br />• <br />Environmental Health Department