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Date: 0 <br />Facility Ad res : <br />Well Address: <br />WP# <br />Inspector: <br />C\6 <br />Well#: <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes ON° <br />To: <br />To: <br />To: <br />To: <br />COMPLETION CI Stove Pipe <br />casing <br />height <br />DChristie Box <br />CHALSTY-BOX <br />COMPLETION <br />Grourx! Sudan <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />SAN3JOAQUIN A7171v <br />—COUNTY <br />cs°15"r e,/ Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Soil Boring#: k I 0 2 jtrACe0:0 5 nieS) <br />Drilling Company: DeA\VA 1,(1(s <br />Driller Onsite: <br />Consultant: IA\ ck Vac\ i'st Aillaj <br />Geologist: P\r \ACCJ <br />Public Water System Onsite: 0 Yes ENo <br />Domestic Well Onsite: LI Yes ONo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: LII Yes ENo <br />SPOILS <br />Contamination Noted: 0 Yes 111No <br />If yes, spoils storage Location: <br />Covered: LIYes EINo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br /> <br />Mask eciAtt‘iii-f- <br />Gallons of Grout Used: 20 - '72_cs O1 <br />0Well Installation EWell Destruction <br /> <br />1,76StAl. <br />DBoring Installation .Boring Destruction <br />METHOD USED <br />EPressure Grout DOver Drill <br /> -1 /4-24;,s1 tr5c: <br />EGravity glTremie DOther: <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 <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 40 80 8 <br />CONSTRUCTION <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Feet Screen Feet <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <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 />Blank <br />Slot Size: <br />,!odkcouli-Bags of Cement: <br />44410MOt Bags Sand/Gravel: <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com