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/7"--;\0.1"111,-;Vul'ilive-1 11t <br />I". 1:t COUNTY— <br />Greatness grows here. <br />ErMilbriffieftital frfiefft <br />Inspector: Date: ttiekla <br />Facility Address: 6..e <br />Well Address: <br />Monitoring Well/Soil Boring Inspection Report <br />WP# 04.7.3ric.3 Well#: <br />Soil Boring#: cion , Zr2_ <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: E Yes No <br />Domestic Well Onsite: 11 Yes uNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: EYes LINo <br />SPOILS <br />Contamination Noted: 0 Yes ONo <br />If yes, spoils storage Location: <br />Covered: EYes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: Co -2.1 <br />Depth to Water: 4 <br />Grout Material: root- <br />Gallons of Grout Used: ill, I IS) <br />ElWell Installation DWell Destruction <br />EBoring Installation 111-8tring Destruction <br />METHOD USED <br />OPressure Grout LIOver Drill <br />Gravity lemie Lather: <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 GO 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />CONSTRUCTION <br />casing <br />iglit <br />ABOVE-GROUND <br />colvPLE-rtoN cd-tRis-ri=sox <br />comPLE-riom <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes ON° <br />To: <br />To: <br />To: <br />To: <br />COMPLETION LI Stove Pipe El Christie Box <br />Grocind Surf <br />grout <br /> ft. <br />slot:2d <br />soclon <br />77Lita <br />ft. <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen <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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 96205 I T 209 468-34201 F 209 464-0138 I www.sicehd.com <br />Feet