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Public Water System Onsite: 0 Yes 0No COMPLETION LI Stove Pipe CIChristie Box <br />0 Yes 0No Verified Chain of Custody: <br />SPOILS <br />0Tremie ClOther: <br />0Well Installation Well Destruction <br />EBoring Installation E ,tiring Destruction <br />METHOD USED <br />111Pressure Grout Over Drill <br />Gravity <br />ty: SA6JOAQUIN <br />,ON0H —COUNTY <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />I nsbector: SkAbirtdr <br />Facility Address: 35 Ilth SV -5,---Auj <br />Well Address: <br />WP# 0 0 3q Well#: <br />Soil Boring#: Ni tAi 1 2— <br />Drilling Company: <br />Driller Onsite h _t• F—t9 Screen Length <br />i-:-IAVirOlAilkijkl-g_Filter Consultant: Pack NtVaA6LO <br />Geologist: RAIL MCIArtl Bentonite <br />Grout <br />Date:WO <br />From: <br />From: <br />From: <br />From: <br />Environmental Health Department <br />Min 2" Annular EHD Seal Verified: CI Yes 0No <br />To: <br />To: <br />To: <br />To: <br />Screening Method: <br />Contamination Noted: 0 Yes EN° <br />If yes, spoils storage Location: <br />Covered: El Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 2_0 ft <br />Depth to Water: <br />Grout Material: NeAt a vAtyvt-- <br />Gallons of Grout Used: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 9411i <br />ags _,..-- <br />Thickest Thinnest # Bags Thickest Thinnest #Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 w 20 2 <br />7.5 15 3 15 ,30 <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 />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% Mik 5% Mix <br />Bentonite per 47 lb 1.41 -241 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-34201 F 209 464-0138 I www.sicehd.com <br />Domestic Well Onsite: 0 Yes ElNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />casing <br />height <br />CHRISTY-430x <br />COMPLETION <br />Ground Surface <br />CONSTRUCTION <br />Total Depth: Zat <br />Drilling Rig Type: