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Yes 111 No Domestic Well Onsite: <br />El Yes El No Verified Chain of Custody: <br />SPOILS <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: eisin Inspector: SC44ViCti <br />Facility Address: g.6 <br />Well Address: <br />wP# O39 cfl <br />Soil Boring#: MW <br />Drilling Company: S(cAL1 Le, <br />Driller Onsite:A <br />Consultant: PV,Var <br />Geologist: 1464- <br />Public Water System Onsite: El Yes 111No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: lii Yes El No <br />If yes, spoils storage Location: <br />Covered: E Yes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth 2bff - <br />Depth to Water: <br />Grout Material: N-eitt 62.XOUVIAJ- <br />Gallons of Grout Used: <br />El Well Installation N91Well Destruction <br />lilBoring Installation Boring Destruction <br />METHOD USED <br />CIPressure Grout )it,lOver Drill <br />IA Gravity lTremie Other: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />(erne <br />Bags <br />Thickest Thinnest tt Bags Thickest Thinnest # Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />11) <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 />CONSTRUCTION gi(HS <br />Total Depth: 2-01 <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br /> <br />Screen Length From: <br /> <br />From: <br /> <br />From: <br />From: <br />Yes lilNo <br />To: <br />To: <br />To: <br />To: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen <br />Slot Size: <br />Feet <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Bentonite/Ce nt Mix 3% Mix (5% MIX <br />Bentonite pe <br />c <br />47 I <br />f. <br />1.41 <br />Bentonite per 9 lb 2.82 4.7 <br />cups of biz r\i-6-yo-c., <br />CDIA-0\L't Filter Pack <br />Bentonite <br />Grout <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 />COMPLETION El Stove Pipe <br />casing <br />height <br />EIChristie Box <br />CHPI1STY-BOX <br />COMPLETION <br />SAWOAQUIN 1-‘ 1 COUNTY <br />iF ve% Greatness grows here <br />Well#: