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cas ing <br />he ight <br />ch,,F3isrr-80x <br />COMPLET19N <br />li1Pressure Grout 1110ver Drill <br />1:7 Gravity <br /> <br />a6--remie ther: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Environment " Heaith Department <br />• Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 11/51 ts Inspector: tale" <br />Facility Address: ivrn <br />Well Address: <br />WP# <br />Soil Boring#: <br />Drilling Company: (Teti, Osp-l4.--3 <br />Driller Onsite: <br />Consultant: AN, 0.4.143(.-5 put. <br />Geologist: -14%"5e I <br />CONSTRUCTION <br />Total Depth: <br />Well#: #‘0../-0/6Drillin g Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes El No <br />To: <br />To: <br />To: <br />To: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <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 />Verified Chain of Custody: El Yes DINo <br />SPOILS <br />Contamination Noted: El Yes DNo <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />eir <br />GROUTING or DESTRUCTION Total Depth:1,014 41446 <br />Depth to Water: ti .c1ç _tar is, ls--pt- <br />Grout Material: ncor <br />Gallons of Grout Used: S-031) 8-07_, <br />EIWell Installation 11'41 Destruction <br />OBoring Installation lilBoring Destruction <br />METHOD USED <br />COMPLETION 111Stove Pipe EIChristie Box <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Yes ElNo <br />El Yes ONo <br />Yes ON° <br />Water <br />gallons <br />Cement Cement 47 lb <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest tl Bags <br />25 5 1 5 10 1 <br />5 10 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 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 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 T 209 468-3420 F 209 464-0138 I www.sicehd.com <br />(2'4P6( <br />i/S