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casing <br />height <br />CHRISTY-BOX <br />COMPLETION <br />Ground Surface <br />grout <br />ft <br />_ft <br />slotted <br />sacrion <br />gravel pack <br />ft. ft. <br />0Well Installation <br />EBoring Installation <br />METHOD USED <br />ElPressure Grout 00ver Drill <br />LIWell Destruction B-Valp:Li <br />6140 oring Destruction <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 111 Yes 0No <br />To: <br />To: <br />To: <br />To: <br />COMPLETION El Stove Pipe 0Christie Box <br /> <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> From: <br />SANdOAQUIN ,.„.., . <br />COUNTY <br />\,,,a1.•`,. -' , <br />ureatness 9 rows here. <br />Environmen Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Covered: <br />If yes, material: <br />Yes El N o <br />0 Yes JJo <br />[1] Yes 0 No <br />y) Gravity <br /> WT . nOther: <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 />Inspector: .B61-11" Date: 7 <br />Facility Address: 0 NI riOn <br />Well Address: <br />WP# V 0 <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: 111 Yes 0N0 <br />Domestic Well Onsite: <br /> E Yes E No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />e9..2o.ft <br />GROUTING or DESTRUCTION Total Depth:_04_,_a514- <br />Grout Material: ,n142,n+43W-S fget <br />Depth to Water: ce <br />Gallons of Grout Used: 12 — a I 1 era MATERIALS/DEVELOPMENTs <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest gBags Thickest Thinnest #Bags <br />2,5 5 1 5 10 1 <br />5 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 7 35 70 7 <br />20 40 8 40 80 8 <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 T 209 468-3420 I F 209 464-0138 I www.sicehd.com