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SANkJOAQUIP <br />COU NT Y— <br />Greatness grows here. <br />Environme II Health Department <br />El Yes ON° Public Water System Onsite: <br />0 Yes EINo Domestic Well Onsite: <br />If yes, location and distance: <br />El Yes EINo Verified Chain of Custody: <br />SPOILS <br />OPr ssure Grout 1110ver Drill 212 <br />Gravity ETremie <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: IA-41X <br />Facility ddr s t)(11 S. <br />Well Address: <br />Well#: S -.3 <br />Soil Boring#: <br />Drilling Company: 194,....e.Ceprr_. i)6-11.1 <br />Driller Onsite: kA tit LA.- <br />Consultant: <br />Geologist: <br />Screening Method: <br />Contamination Noted: 0 Yes 0 No <br />If yes, spoils storage Location: <br />Covered: 0 Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />DWell Installation gWell Destruction <br />0 Boring Installation El Boring Destruction <br />METHOD USED <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <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 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 />wp# k—g)c)03 —14 , , <br />SAMPLING <br />Holding Temperature: <br />Method: <br />CONSTRUCTION <br />MATERIALS/DEVELOPMENT <br />Casing Type: 114/1r— <br />1/5 <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Blank 7 Feet Screen <br />Slot Size: <br />Bags of Cement: <br />Feet <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 Stockton, California 95205 I 1 209 468-3420 F 209 464-0138 1. www.sicehd.com <br />Total Depth: ) <br />Drilling Rig Type: <br />COMPLETION El Stove Pipe <br />casing <br />height <br />ErChristie Box <br />C,FORISTY-BOX <br />COMPLETIchl <br />nnul <br />Filter Pack <br />Bentonite <br />Grout <br />r EHD Seal Verified: <br />Li 1 <br />7., I <br />121es JLA. <br />To: <br />To: <br />To: <br />To: • <br />From: <br />From: <br />From: <br />From: