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CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />111 Yes EINo <br />To: <br />To: <br />To: <br />To: <br />From: <br />From: <br />From: <br />From: <br />SACOAQUIN <br />OUNTY— <br />Grect.ners grows here. <br />Environmer Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 7Inspector: kiltv <br />Facility A dre s C7to (v) CAA4b Well Address: SCA---47-- <br />\A/p# I-IP 00376 <br />, <br />Well#: • <br />Soil Boring#: 4 i - <br />Drilling Company: 5.A,Op-Or..4k.....4-41 ceiv—dio I Add c, <br />Driller Onsite: kre.11 —41;bcf,b1 <br />Consultant: <br />Geologist: <br />Public Water System Onsite: CI Yes EINo <br />Domestic Well Onsite: El Yes F.:No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />IViethod: (Brod nd Surface A <br />Screening Method: • grout <br />Verified Chain of Custody: El Yes EN° <br />Si i <br />ft <br />ft ft <br />If yes, spoils storage Location: <br />CI Yes ON° <br />t. tin turd <br />It. <br />aavion I I grastpl pack <br />/ <br />f <br />' <br />SPOILS <br />Contamination Noted: 111 Yes ON° <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank 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 />f\t54- sdc, <br />COMPLETION El Stove Pipe OChristie Box <br />casing <br />height <br />ABOVE-GROUND <br />MPLETIO N CHRISTY-BOX <br />COMPLETION <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:U-1i 3N/04;0 <br />e.4,4- <br />Depth to Water: r ip <br />Grout Material: <br />' <br />Gallons of Grout Used: /0 eillok <br />ElWell Installation OWell. Destruction <br />IIIBoring Installation lilBoring Destruction <br />METHOD USED <br />ElPressure Grout 11:10ver Drill <br />CI Gravity liTremie DOther: <br />Screen <br /> <br />Feet <br /> <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # Bags <br />2.5 5 1 5 10 1 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 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 40 80 8 <br />Bentonite per 94 lb <br />Bentonite per 47 lb <br />Bentonite/Cement Mix 3% Mix <br />2.82 <br />1.41 <br />5% Mix <br />2.47 <br />4.7 <br />.3 8),/,er 10/16/2 017 <br />1868 E. Hazel ton Avenu I S ockton,7alifornia 95205 f T 209 468-3420i F 209 4640138 T, www.sicehd.com