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Total Depth: I-1) <br />Drilling Rig Type: Srl'atv, <br />Min 2" Annular EHD Seal Verified: Ees El No <br />Screen Length From: la VO TO: VO <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From: a <br />From: 2,5 <br />From: •114-I 3 <br />11 I Stove Pipe <br />To:27, t, <br />To: Sti..r444._ <br />[Dt<ristie Box <br />casing <br />height <br />A3O.—VE-6ROUND <br />COMPLETION <br /> <br />CI-FUSTY-BOX • <br />COMPLETION <br />SAI\VJOAQUIN <br />COUNTY <br />Greatness 9ro4S here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: voo/ig Inspector: 1.-or )601e CONSTRUCTION <br />Facility Address: COurtfry Club Skid <br />Well Address: <br />v vp# 6:7 2 641&• Weft XAAJ -1C 1-7:41.1 <br />Soil Boring#: <br />Drilling Company: All <br />Driller Onsite: -PC* CAl /4.-4riclenvrie/ti- <br />Environmen Health Department <br />Consultant: /1-67 <br />El Yes ON° <br />Yes EINo <br />Geologist: TArtireA <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />ft <br />ft <br />Verified Chain of Custody: <br />SPOILS <br />Yes EINo <br /> <br />Contamination Noted: LI Yes IIINo <br />If yes, spoils storage Location: <br />Covered: LI Yes El o <br />ft <br />If yes, material: <br />9. GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: ev,a)\-- <br />Gallons of Grout Used: <br />II Installation IEIWell Destruction <br />LIBoring Installation ElBoring Destruction <br />METHOD USED <br />111Pressure Grout 1110ver Drill <br />LI Gravity 1:10ther: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <1,1'• •-GC' <br />Blank ,c) SO Feet Screen 1.6 Feet <br />Slot Size: oto <br />Bags of Cement: 4- ‘t 2, 4- 441- <br />Bags Sand/Gravel: t-2- <br />Type/Brand of Bentonite: revert, <br />Filter Pack Type/Size: -Sr- 3 <br />Type of Method: <br />water <br />gallons <br />Cement 47 lb <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest ilt Bags Thickest Thinnest 4 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 GO 6 <br />17.5 35 7 35 70 7 <br />20 40 a 40 80 8 <br />BentonitelCement Mix 3% Mix 5% Mix <br />E3entonite 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 l Stockton, California 95205 T 209 468-3420 F 209 464-0138 I www.sicehd.com