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10/16/2017 <br />1868 E. Hazeiton Avenue! Stockton, California 95205J T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />SAN JOAQUIN <br />COUNTY <br /> Environme,nt -" HeaRh Department <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />D Yes El No <br />D Yes LI No <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />LI Gravity lmie Ether: (4•1 ve. <br />Date: / Inspector: <br />Facility Address: <br />Well Address: <br />WP# Well#: f Ogfr -- j,, <br />Soil Boring#: Poor - <br />GievIl on, 1,ties <br />Consultant: kyr,,itt,s <br />Geologist: -,\,t t./1 -T sbre, <br />Screening Method: <br />Verified Chain of Custody: El Yes DNo <br />SPOILS <br />Contamination Noted: Li Yes ON° <br />If yes, spoils storage Location: <br />Covered: 117 Yes lElNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:n <br />Depth to Water: t 3 <br />Grout Material: e‘..e."Is. <br />Gallons of Grout Used: 3005 I <br />. OWell Installation 0411 Destruction <br />EBoring Installation lilBoring Destruction <br />METHOD USED <br />IIIPressure Grout DOver Drill <br />Water <br />gallons <br />Cement 471b <br />Bags <br />water <br />gallons <br /> - <br />cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest 41 Bags <br />2,5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7,5 25 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 AO 80 8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />El Yes D No <br />To: <br />To: <br />To: <br />To: <br />111Christie Box <br />cas trig <br />height <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 />Bentonite/Cement Mix 3% Mix 5% Niix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />Drilling Company: <br />Driller Onsite: <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION LI Stove Pipe <br />From: <br />From: <br />From: <br />From: