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0 Yes IIINo Domestic Well Onsite: <br />eoproi*. <br />If yes, material: <br />GROUTING or DESTRUCTRN Total Depth: 5(i-A-, <br />Depth to Water: 25¼4. <br />Grout Material: <br />LI Well Installation El Well Destructi 55+,40 <br />5500 <br />Y) <br />111Boring Installation Li Boring Dest <br />METHOD USED <br />111Pressure Grout 00ver Drill <br />El Gravity <br /> <br />ElTremie 1710ther: <br />casing <br />height 03401114vAg <br />ABOVE-GROUND <br />(X)MPLETION CHR1STY-BOX <br />COMPLETION <br />6,6 • <br />SAN.,,JOAQUIN 4 <br />111 COUNTY <br />Greatness grows here <br />Date: 61—\/:\ )---\ Inspector: c6a.-L-00.5. <br />Facility Address: 2.3•5 \\\ • R-_) '5$\,a.vO <br />Well Address: <br />wP# OC) Well#: <br />Environmental Health Department <br />Tbrvkiairre‘O <br />1 (3';3°--lictou <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Monitoring Well/Soil Boring Inspection Report <br />Soil Boring#: <br />Drilling Company: 0.51(NCeakQ . <br />Driller Onsite: r*Q09—Ge • <br />1-11‘c/ bitgef5i Geologist: <br />Public Water Water System Onsite: 0 Yes 0No <br />Consultant: <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />0 Yes ENo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION El Stove Pipe CI Christie Box <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes 111No <br />SPOILS <br />Contamination Noted: 111 Yes 111No <br />If yes, spoils storage Location: <br />Covered: El Yes 111N0 <br />\ '5c 1- <br />Water <br />5/allons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest /nags Thickest Thinnest flags <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 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 />added 40_, <br />MATERIALS/DEVELOPMENT <br />2 M-}95 kiN <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 />, <br />10/16/2017 <br />Gallons of Grout Used: <br />R 50-at". <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Bags of Cement: <br />LP Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />TcVMQ1,5 <br />IVO_ Sol <br />apd <br />siale5 <br />\-60k41,, <br />MOt ()tn(1 I <br />gravel Padc <br />OtA-1111.614‘014-1:4 <br /> ft. (014.hete-, <br />brx borl' <br />2' <br />Ly-k <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />.9-