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Monitoring Well/Soil Boring Inspection Report <br />Inspector: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 111 Yes ON° <br />To: <br />To: <br />To: <br />To: <br />Date: <br />Facility Address <br />Well Address: <br />WP # 0 OR, <br />Soil Boring#: <br />11. <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br />From: <br />casing <br />height <br />ABOVE-GROUND <br />CX)MPLET1ON CHPUSTY-BOX <br />COMPLETION <br /> ft. <br />SANIJOAQUIN <br />COUNTY— <br />Greatness grows here <br />Environmental Health Department <br />Public Water System Onsite: ID Yes li1No COMPLETION 111 Stove Pipe IDChristie Box <br />Domestic Well Onsite: El Yes El N o <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: LI Yes 111No <br />SPOILS <br />Contamination Noted: CI Yes 111No <br />If yes, spoils storage Location: <br />Covered: III Yes 111N0 <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 36/ )S730/361 5-Y- ' <br />Grout Material: ne_ct. <br /> <br />Depth to to Water: Ni_tkiasi-zer • i <br />S V , /Casing Type: <br />MATERIALS/DEVELOPMENT Gallons of Grout Used: I I- 4 I <br /> <br />Eli Well Installation DWell Destruction 'alai 16 a <br />I 4 <br /> Blank Feet Screen Feet <br />-) / <br />E N <br />Slot Size: <br />Boring Installation Bring Destruction 6of- <br />METHOD USED <br />LllPressure Grout LlOver Drill <br />E Gravity KTremie ElOther: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest IBags <br />2.5 5 1 L„..-. 5 10 1 <br />5 10, , 2 g....- 10 20 2 <br />7.5 151/ , 3 ....— 15 30 3 <br />10 20" 4 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 />BentonitelCement 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 />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com