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Yes ON° Verified Chain of Custody: <br />SPOILS <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Environment ° Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2./&t /' Inspector: t------- 2(iN 0') CONSTRUCTION <br />Facility Address: 140-7 7 <br />Well Address: <br />WP# Well#: <br />Soil Boring#: <br />Drilling Company: <br />SAMPLING <br />Holding Temperature: <br />Method: <br /> <br />),S0 1-41 <br />Driller Onsite: it-toCcoi.Vt- <br />Consultant: A.c,a31,=-1- <br />Geologist: 9.A., V.SG/V.A. <br />Public Water System Onsite: CI Yes LIN° <br />Domestic Well Onsite: LI Yes ON° <br />If yes, location and distance: <br />CHF31-STY-0)( <br />COMPLEMON <br />Grosirod Surfaco <br />Screening Method: <br />Contamination Noted: El Yes IEINo <br />If yes, spoils storage Location: <br />Covered: LIYes LINo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 19 _ et, <br />Grout Material: cA- <br />Gallons of Grout Used: 7A) 3 5 <br />OWell Installation IP</ell Destruction <br />EBoring Installation ElBoring Destruction <br />METHOD USED <br />.1Kessure Grout ElOver Drill <br />LI Gravity emie N6t h e r: ICAO. VIAN.. <br />Water <br />gallons <br />cement 471b <br />Bags <br />Water <br />gallons <br />cement 941b <br />Bags <br />Thickest Thinnest 4Bags 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 s '25 50 5 <br />15 30 6 30 60 6 <br />17,5 35 7 35 70 7 <br />20 AO 8 40 80 8 <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <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 />ft. <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 www.sicehd.com <br />)MIJUMtJUlIN <br /> COUNTY <br />Greatness grows here <br />COMPLETION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes El No <br />To: <br />To: <br />To: <br />To: <br />LI Stove Pipe ID Christie Box <br />casing <br />height <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: