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SAN.JOAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />yfYes ENo <br />O 'es c2No <br />If yes, location and distance: <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />Boring Destruction 0Boring Installation <br />METHOD USED <br />Yes EINo <br />To: <br />To: <br />To: <br />To: <br />Min 2" Annular EHD Seal Verified: <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />Feet Blank Feet Screen <br />Slot Size: <br />Monitoring Well/Soil Boring Inspection Report <br />Date: \.S\\.1-10\'LN Inspector: <br />Facility Address: Ro\\50 \1)\\*J`)\ <br />Well Address: <br />WP# We11#: <br />Soil Boring#: t <br />Drilling Company: 'S <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />SAMPLING \\\ <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: I=] Yes IiINo <br />SPOILS <br />Contamination Noted: El Yes No <br />If yes, spoils storage Location: <br />Covered: 0 Yes ONo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: —1.5Z) <br />Depth to Water: \•3 <br />Grout Material: t.c- <br />Gallons of Grout Used:••4\. ‘-e-C cs'‘ <br />1=IWell Installation LI Well Destruction <br />Pressure Grout lilOver Drill <br />113S <br />p Gravity ElTremie ElOther: <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 G4) q.) 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 3 15 80 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 J <br />5 c) 7 35 70 7 <br />20 40 80 8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />COMPLETION 0 Stove Pipe <br />casing <br />height <br />lilChristie Box <br />MATERIALS/DEVELOPMENT \c\ <br />Casing Type: <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 />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-3420 1 F 209 464-0138 I www.sicehd.com