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O1-11:3151Y-PDX <br />COMPLETION <br />SAN ,JOAQUIN <br />COUNTY <br />Greatness grows here <br />Environmeni Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />t f Date: "vv/ ig Inspector: )--gri. )44 *"" <br />Facility Address: 2%51 C4-44 (070 <br />Well Address: <br />WP# 0,0 "VITI• -Two <br />Soil Boring#: <br />Drilling Company: 1+11 Lof <br />Driller Onsite: Onsite: <br />Consultant: OkIr <br />Geologist: .toel."%t..‘ <br />Public Water System Onsite: 1=IYes ENo <br />Domestic Well Onsite: Ill Yes ElNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />CONSTRUCTION <br />Total Depth: 1.5 ) S-7) <br />Drilling Rig Type: At kityju,y cdrY,10... <br />Min 2" Annular EHD Seal Verified: t<'es 0 No <br />From:Sa 1-11) To: <br />From: ill vt To: f,..,5) <br />From: 2- IA— To: <br />From: 2,&" To: <br />IliKove Pipe Ei"Kristie Box <br />ca8lflg <br />height <br />ABOVE-GROUND <br />COMPLETION <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />Verified Chain of Custody: III Yes EN° <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Covered: <br />If yes, material: <br />0 Yes 0No <br />If yes, spoils storage Location: <br />0 Yes 0No <br />fL <br />ittotutd <br />itsclon <br /> 1 I <br />----A SPOILS <br />Contamination Noted: <br /> <br />Grout Material: <br />Gallons of Grout Used: <br />LI Well Installation El Well Destruction <br />El Boring Installation IIIBoring Destruction <br />METHOD USED <br />DPressure Grout 00ver Drill <br />El Gravity LiTremie 00ther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 94113 <br />Bags <br />Thickest Thinnest # 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 60 6 <br />17,5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />MATERIALS/DEVELOPMENT <br />Casing Type: evz.__ ‹r j, <br />Blank S >-.0 Feet Screen <br />Slot Size: - oz42 <br />Bags of Cement: 4 *LA. j,.sit 3 <br />Bags Sand/Gravel: t,‘ t <br />Type/Brand of Bentonite: e-....e,)1/440.-•0-. <br />Filter Pack Type/Size: ir <br />Type of Method: <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 />Feet <br />10/16/2 017 <br />68 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420J F 209464-0138 www.sicehd.com