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Gnxirxi S Lex* <br />cmsri-eox - <br />COMPLETION . . . <br />--1 <br />ABOVE-GROUND <br />cotzriznon <br />casing <br />height <br />ft. <br />ft <br />ft. <br />slotted <br />sac:km <br />gray* pack <br /> t. ft. <br />COUNTY <br />4 ":;:‘-.1./ Greatness grows here. <br />Environment -1 Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:/ l-1/( ae/V1 CONSTRUCTION <br />Facility Addre s: 5 7-0(.4)v,- "‘r- <br />Well Address: <br />Drilling Company: <br />L Driller Onsite: te: Screen ength <br />Consultant: W,Ot I GI. jit AS.SCcrivul-CS <br />Geologist: _Toe CLSCvL 19e.Ary,-,‘ <br />Public Water System Onsite: El Yes LIN° <br />Total Depth: <br />WP# 003 cs GI Well#: Drilling Rig Type: <br />Soil Boring#: - --4- <br />rAiiii,Min 2" Annular EHD Seal Verified: LI Yes ON° <br />To: <br />To: <br />To: <br />To: <br />Bentonite <br />Grout <br />Filter Pack <br />COMPLETION <br />From: <br />From: <br />From: <br />From: <br />D Stove Pipe El Christie Box <br />Domestic Well Onsite: LI Yes 111Nlo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes 111No <br />SPOILS <br />Contamination Noted: LI Yes lilNo <br />If yes, spoils storage Location: <br />Covered: EIYes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: S / <br />Depth to Water: VlOvv2, <br />Grout Material: CgAng.bvt+ <br />Gallons of Grout Used: VD- <br />LI Well Installation OWell.Destruction <br />lilBoring Installation <br />METHOD USED <br />OPressure Grout 00ver Drill <br />I=1 Gravity DTremie Wther: firei A II <br />Water <br />gallons <br />Cement 47 I b <br />Bags <br />Water <br />gallons <br />Cement 941b <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 8 <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 1.41 247 <br />Bentonite per 94 lb 2.82 4.7 <br />7 : oring Destruction <br />10/16/2017 <br />1868 E. Hazelton Avenue J Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com