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casing <br />1-f- height <br />ABOVE-GROUND <br />cowLE-non <br />11 <br />SANIJOAOU I N <br />,z) —COUNTY / Greatness grows here. <br />Environmee Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: <br />Facility Address: <br />Well Address: Total Depth: <br />WP# 003S (06 1 Well#: Drilling Rig Type: <br />Soil Boring#:C,I-4& "S5 -(0 - 6/1 <br />Min 2" Annula Drilling Company: -re& 1\)c,r-4-14-1/4... Ca 1110 V-161 S creen Length <br />Consultant: <br />Driller Onsite: ,ievaa (.4_14 t Assoc. (aAes Filter Pack <br />Geologist: Toe_ /21.4).se-i"._ Bentonite <br />Grout <br />Inspector: A/L/iatrYt• vtx_ <br />El I <br />CONSTRUCTION <br />From: <br />From: <br />From: <br />From: <br />r EHD Seal Verified: CI Yes 0No <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: E Yes 0No <br />COMPLETION 0 Stove Pipe 0Christie Box <br />Verified Chain of Custody: 0 Yes 0No <br />SPOILS <br />Contamination Noted: 0 Yes 0No <br />If yes, spoils storage Location: <br />Covered: 0 Yes EN° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:5' IO' ' 10 51 , , vV2- Depth to Water: <br />Grout Material: <br />Screening Method: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Domestic Well Onsite: 17:1 Yes ENo <br />If yes, location and distance: <br />t/Lea+ <br />Gallons of of Grout Used: 1/2., I 1 <br />0Well Installation EWell ,Destruction <br />0Boring Installation oring Destruction <br />METHOD USED <br />EPressure Grout DOver Drill <br />0 Gravity 0Tremie $10ther: --(KM f <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 />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 />s 3.0 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 1 209 468-3420 I F 209 464-0138 I www.sicehd.com