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Yes ENo Verified Chain of Custody: <br />SPOILS <br />Grout From: <br />El Yes EINo <br />To: <br />To: <br />To: <br />To: <br />SANAOAQUIN <br />COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Environmer Health Department <br />Date: Inspector: beAeviCiivvy ivkg, <br />Facility Address: g. I I t" 5 <br />Well Address: <br />wP# 00?-1S66, () <br />Soil Boring#: <br />Drilling Company: -1-E & 1\)CM---VAA.Q.Ar" <br />Driller Onsit Cie/AA <br />Consultant: <br />Geologist: <br />e: <br />Domestic Well Onsite: El Yes EN° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: ID Yes ENo <br />If yes, spoils storage Location: <br />Covered: LI Yes 0No <br />If yes, material: <br />Gallons of Grout Used: <br />111Well Installation DWell.Destruction <br />111Boring Installation poring Destruction <br />METHOD USED <br />OPressure Grout DOver Drill <br />111 Gravity ETremie Wther:-Aralek-( <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # Bags 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 a <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />El Christie Box COMPLETION 0 Stove Pipe <br />casing <br />I height <br />CHRLSTY-EOX - <br />COMPLETION <br />ABOVE-GROUND <br />CON.i.L.Enorq <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 />Well#: <br />vv <br />Joe. PLoseivk...beArvy <br />Public Water System Onsite: II Yes 0No <br />cia.1 i coretie,,Min 2" Annular EHD Seal Verified: <br />Screen Length From: <br />,4 Filter Pack From: <br />Bentonite From: <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 />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />VI 0 V1_12- <br />2a-f - ceAft&e.vIA-- <br />oi