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Yes ON° <br />Yes ONo <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />DI Yes EINo <br />Contamination Noted: <br />El Yes DNo <br /> <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />Stove Pipe COMPLETION El Christie Box <br />oo: SANAOAQUIN <br />MTV— <br />' reotne.s.s grows here • <br />WP# p-o3e(3 9 We11#: <br />Soil Boring#: -Z. cr, I 1 0 a - <br />Drilling Company: A-cre <br />Driller Onsite: <br />Consultant: filrg <br />Geologist: .1)0-inite, <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: D Yes ONo <br />SPOILS <br />GROUTING or DESTRUCTION Total Depth: <4, 6-A-1 ( trt <br />Depth to Water: 0 <br />Grout Material: Nt <br />Gallons of Grout Used:3-5 et 3 I <br />El Well Installation DWell Destruction <br />El Boring Installation [Efrocing Destruction <br />METHOD USED <br />DPressure Grout 00ver Drill <br />ILI'6•avity OTremie DOther: <br />Water <br />gallons <br />Cem ent 47 lb <br />Bags <br />Water <br />:allons <br />Cement 54Ib <br />B : <br />Thickest Thinnest # Bags Thickest Thinnest 4 Bags <br />2.5 5 1 5 10 1 s 10 2 10 20 2 7.5 15 s 15 so 3 <br />10 20 4 20 40 4 12.5 25 5 '25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Environirnenta Dan Department <br />Screen Feet <br />BentoniteICement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb , i 2.82 4.7 <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 11 tX Inspector: CONSTRUCTION <br />Facility Address: -f3 &J 1-(A.44(CSoi, <br />Well Address: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank 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 />10/16/2017 Acksi-ld At..41w ,SV +1. rtArv.•-t. <br />1868 E. Hazelton Avenue Stockton, California 95205 J T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: D Yes IDNo <br />To: <br />To:• <br />To: <br />To: <br /> ea.$.ng <br />height <br />ABOVE-GROLIND <br />COMPLETION CHRISri*X <br />COMPLETICN • <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br /> <br />From: <br /> <br />From: <br />From: