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COUNTY - <br />gi-S L <br />COMPLETION El Stove Pipe CIChristie Box <br />graval pacils <br />casing <br />height <br />cl-t19ISTY-430X <br />COMPLETIpN <br />GoxindSurfaco <br />grout <br /> ft <br />Shl h,441`4 <br />akstrad <br />Ito-clon <br />ft. <br />1 leallth Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 5/1/41 Inspector; )(Lei <br />Facility Address: Is yi <br />Well Address: So"v-t, <br />WP# Well#: <br />Soil Boring#: S.1 <br />Drilling Company: psc,41. <br />Driller Onsite: ic-4,P3AN <br />Consultant: C <br />Geologist: <br />Public Water System Onsite: <br />El Yes 111No <br />Domestic Well Onsite: <br />Yes EINo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />0 Yes EINo <br />SPOILS <br />Contamination Noted: CI Yes EINo <br />If yes, spoils storage Location: <br />Covered: 0 Yes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 7...40-ft) <br />Depth to Water: d <br />Grout Material: "ctas- <br />Gallons of Grout Used: 1.- cc, <br />) I 3 <br />ElWell Installation CI Well Destruction <br />EBoring Installation <br />Boring Destruction <br />METHOD USED <br />LIPressure Grout 00ver Drill <br />I2/Gravity 0Tremie 00ther: <br />Water <br />gallons <br />Cem ent 47 lb <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest 4 Bags <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 il 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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes 0No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <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 />10/16/2 017 <br />1868 E. Hazelton Avenuef Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 www.sicehd.com