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CONSTRUCTION <br />Total Depth: <br />Drilling Rig Rig Type: 1-1.31X-otr <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />From:T/3 a <br />From: Mit( <br />From: 7.1 <br />From: 2, 2,A- <br />111Stove Pipe <br />N o <br />To: "?.--r/ s-b. <br />To: vs-, <br />To: <br />To: <br />P6ristie Box <br />Mm 2" 2" Annular EHD Seal Verified: [?''es <br />casing <br />height <br /> <br />C118151Y-PDX <br />COMPLETION <br />MATERIALS/DEVELOPMENT <br />Casing Type: 4--to <br />Blank s" o Feet <br />Slot Size: <br />Screen <br /> <br />Feet <br /> <br />SAI\IJOAQUIN <br />CO U NT Y— <br />Gre.one.ss grows here <br />Environmen Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: [13) g <br />Facility Address: -7,1,-(/ <br />Well Address: <br />WP# <br />Soil Boring#: <br />Drilling Company: Alt 6-4,0 <br />Driller Onsite: (2-619 <br />Inspector: U., <br />Well#: <br />Yes El N o <br />Yes ON° <br />Consultant: A-C.r-E <br />Geologist: e <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />7 - <br />Verified Chain of Custody: CI Yes El NI o X' SI <br />4 / <br />GROUTING or DESTRUCTION Total Depth: SO) 1, <br />Depth to Water: <br />5 <br />Covered: <br />If yes, material: <br />If yes, spoils storage Location: <br />El Yes 111 N o <br />-ft <br />alettacl <br />soclon <br /> 1 I <br />SPOILS <br />Contamination Noted: IEI Yes 0 No <br />Grout Material: out,A- e,t,.._4vv4 <br />Gallons of Grout Used: 4111F 4, 5171 <br />Ea6ell Installation DWell Destruction <br />Bags of Cement: till q(/14 1'"55i <br />Bags Sand/Gravel: t1 /4 <br />Type/Brand of Bentonite: Pe\c.titS'......\. c..A"-.3•1 <br />Filter Pack Type/Size: Ait3 <br />Type of Method: <br />Screening Method: <br />lilBoring Installation LI Boring Destruction <br />METHOD USED <br />DPressure Grout lilOver Drill <br />El Gravity Viremie DOther: <br />Water <br />gallons <br />cement 47W <br />Bags <br />water <br />gallons <br />cement 94W <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest 4 Bags <br />2.5 5 1 5 10 1 <br />5 3.13 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 s 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 AO 80 8 <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 1 209 468-3420 J F 209 464-0138 www.sicehd.com