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To: <br />To: <br />To: <br />To: <br />From: <br />From: <br />From: <br />From: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION 111 Stove Pipe <br />casing <br />height <br />CHRISTY-BOX <br />COMPLETION <br />CIChristie Box <br />Total Depth: <br />Drilling Rig Type: 1-isk Lt" <br />Min 2" Annular EHD Seal Verified: ID Yes EINo <br />SANJOAQUIN <br />Ii COUNTY <br />Public Water System Onsite: El Yes ID N o <br />Domestic Well Onsite: 111 Yes CI N o <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: I=1 Yes ONo <br />SPOILS <br />Contamination Noted: LI Yes ONo <br />If yes, spoils storage Location: <br />Covered: LiVes li1No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: y1,9AL-A <br />Grout Material: /V,e (..WiteAk-4 <br />Gallons of Grout Used: /‘-'t <br />t941). <br />El Well Installation LI Well Destruction <br />El Boring Installation Sr, oring Destruction <br />METHOD USED <br />El Pressure Grout IDOver Drill <br />>7fGravity IDTremie DOther: <br />Water <br />gallons <br />Cemen(4_71 Jo <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest /1 Bags Thickest Thinnest 4 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 />iq, vi,1 3 10 <br />Environmental Health Department <br />Report <br />CONSTRUCTION <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% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />10/16/2017 <br />Facility Address: <br />Well Address: <br />WP# 004 I Well#: <br />Soil Boring#: 6 I <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: yut_ t 141$1 <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection <br />Date :1/4/i Iroispekto: <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com