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SANAOAQUIN ; COUNTY- -- <br />\:,141,060' Greatness grows here <br />Environmental Health Department <br />Filter Pack <br />Bentonite <br />Grout <br />From: To: <br />From: To: <br />From: To: <br />0 Stove Pipe COMPLETION LIChristie Box Public Water System Onsite: 0 Yes lilNo <br />Yes ON° Domestic Well Onsite: <br />If yes, location and distance: <br />Yes ON° Verified Chain of Custody: <br />SPOILS <br />Tremie 0 Gravity <br />Date: <br />Facility <br />Soil Boring#: 6/ , 62_ <br />Drilling Company. Ht (Dc; 11; n <br />Driller Onsite: <br />meriaPv) lichet/744 fer0-44 Consultant: ov <br />Geologist: /4 <br />CONSTRUCTION <br />Total Depth: 9 " 4 Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes IllNo <br />Screen Length From: To: <br />LI I nspect:Tr: )64e7 <br />ddress:V-9 -760 0 til-Akry? <br />Well Address: <br />WP#0041q/11 <br />Monitoring Well/Soil Boring Inspection Report <br />Well#: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />casing <br />height <br />C4-iFITSTY-BOX <br />COMPLETION <br />Ground Surface <br />Contamination Noted: 0 Yes 0 No <br />If yes, spoils storage Location: <br />Covered: ID Yes 0 No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: IS <br />Depth to Water: i2.-15 C.+ <br />Grout Material: /141,94--F <br />Gallons of Grout Used: <br />El Well Installation 0 Well Destruction <br />0 Boring Installation <br />METHOD USED <br />li1Pressure Grout lilOver Drill <br />Water <br />gallons <br />Cemen 7Ib <br />Ba <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest //Bags Thickest Thinnest flags <br />2.5 5 1 5 10 1 <br />s 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 35 70 7 <br />20 (716-) ft) 40 80 8 <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 />Screening Method: <br />50 , <br />oring Destruction <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com