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SANAOAQUIN <br />amika:<, COUNTY <br />Greatness yrows here. <br />EnvironmerL Health Department <br />LI No Public Water System Onsite: 0 Yes <br />0 Yes 0No Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: EYes EN° <br />If yes, material: <br />2G+ f- <br />E Yes <br />GROUTING or DESTRUCTION Total Depth: <br />Grout Material: <br />Gallons of Grout Used: 1- 1 qoi ons <br />Depth to Water: <br />11 at- (7)1e/(1 <br />Well Installation 0Well Destruction <br />casing <br />height <br />CHRISTY-BOX <br />COMPLETION <br />gravol pacit <br />ft <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: 6TTy fhà <br />Facility Ad ress: 540 NI. <br />Well Address: \A P 0032) <br />WP# Well#: <br />Soil Boring#: B I A-2_ <br />Drilling Company: pe cope, pr, N (40 <br />Driller Onsite: 11,jAt <br />Consultant: IR -1Ni 70114 <br />Geologist: <br />Domestic Well Onsite: 0 Yes 0No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Boring Installation oring Destruction <br />METHOD USED <br />Pressure Grout 00ver Drill <br />Gravity IATremie DOther: <br />V: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest #Bags Thickest Thinnest ItBags <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 />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />COMPLETION 0 Stove Pipe 0Christie Box <br />Grourgi Surface <br />grout <br /> ft <br />_ft <br />slattod <br />sacten <br />1 ft. <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />0 Yes 0No <br />To: <br />To: <br />To: <br />To: <br />From: <br />From: <br />From: <br />From: <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 141 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 <br />e--T