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SANAAQUIN <br />COUNTY— <br />./ Greatness grows here. <br />Environmental Health Department <br />1/No <br />gNo <br />Public Water System Onsite: LI Yes <br />Domestic Well Onsite: El Yes <br />Depth to Water: <br />Yr Yes CINo <br />If yes, spoils storage Location: <br />Covered: g Yes IIINo <br />If yes, material: 5' 5" 05 ‘4, tit ovx t> Aft $ <br />GROUTING or DESTRUCTION Total Depth: "7, <br />5% LIkA-dc <br />Grout Material: 3U,k L-t,APAA/91- <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 1 I s2 Inspector: V.1" owle1-6-brix-tke <br />Facility Address: Co LA.v.A-1 L.1.440 <br />Well Address: vi <br />WP# '0)3(9 Well#: stk, - <br />Soil Boring#: <br />A k,t. Lt. Alifra4 tiv‘ 01-444,* <br />fr.,,,ki? 0.../A.)iiv•- <br />A cr_E <br />Geologist: k‘.1\ vkie,tv\ <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperatu <br />Method: <br />Screening M <br />Yes ONo <br />Gallons of Grout Used: ':7c s &LL 0L4 <br />LII Well Installation Cl Well Destruction <br />El Boring Installation El Boring Destruction <br />METHOD USED <br />IIIPressure Grout DOver Drill <br />71.6ravity 'STremie 1110ther: <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 />CONSTRUCTION <br />Total Depth: 1, <br />Drilling Rig Type: .4-014,044) <br />From: 7.7 To: 0 <br />From: To: 3 <br />From: 1 To: <br />Min 2" Annular <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />EHD Seal Verified: lYes 111No <br />From: Z -5- To: 5- <br />COMPLETION El Stove Pipe Ichristie Box <br />ABOVE-GROUND <br />COMPLETION <br /> Ground Suriace <br />te. <br />rt. <br />ft. <br />casing <br />height <br />MATERIALS/DEVELOPMENT <br />Casing Type: (_. ,cA 4c2 <br />Blank 5 ' Feet Screen 2-0 Feet <br />Slot Size: 0 <br />Bags of Cement: <br />Bags Sand/Gravel: 1 k <br />Type/Brand of Bentonite: 'i?v-v-olWUL.A.5M cjiLie5 <br />Filter Pack Type/Size: 4.1- 3 1—D <br />Type of Method: 1.1'4,vvt-i tx4 <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 />Verified Chain of Custo <br />SPOILS <br />Contamination Noted: <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 />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />od: