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casing <br />height <br />ft. <br />Environment ° Heath Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2.4 f t Inspector: --er/ CONSTRUCTION <br />Facility Address: vie 11 1 Ph, <br />Well Address: Total Depth: <br />WP# Well#: (001(-1$51P10114Crilling Rig Type: <br />Soil Boring#: ErDt <br />Mmn 2" Annular EHD Seal Verified: Drilling Company: Ural? n <br />Driller Onsite: <br />Consultant: forre,..410,5 <br />Geologist: Pcv.....tA TovinvA6 <br />Public Water System Onsite: 111Yes LINo <br />Domestic Well Onsite: I=1 Yes El N o <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br /> <br />Screening Method: <br />Verified Chain of Custody: <br />El Yes EINo <br />SPOILS <br />Contamination Noted: <br />ID Yes lEINo <br />If yes, spoils storage Location: <br />Covered: El Yes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: al) tst-9-41445— <br />Depth to Water: Vej 3. e l A II. 30 <br />Grout Material: v Cen"4""A. <br />Gallons of Grout Used: FA)) <br />OWell Installation eli Destruction <br />111Boring Installation El Boring Destruction <br />METHOD USED <br />CIPressure Grout ClOver Drill <br />CI Gravity Vremie 'Other: C.AttlacCvat <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest 43ags <br />2,5 5 1 5 10 1 s 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 />4- t <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION CI Stove Pipe <br />CI Yes ON° <br />To: <br />To: <br />To: <br />To: <br />111Christie Box <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 />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 I F 209 464-0138 vvww.sicehd.com <br />10•5-