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COMPLETION LI Stove Pipe <br />heigh <br />.113EZVE-GROUND <br />COWLETION <br />Christie Box <br />COUNTY <br />,_reatness grows here. <br />..... • • .G1Pe. . • .., . 4:••• • .7•• • et. <br />Mon, .-ing Well/Soil Boring Inspectic,,, Report <br />Date:Inspector: <br />Facility ddress: -7),) CA.-w orse/ 44-- <br />Well Address: <br />WP# 0i)3c1i Well#: <br />Soil Boring#: <br />Drilling Company: Company: iff.4-avv,),,‘„,„,,,,.,„A-AA, <br />Driller Onsite: <br />Consultant: Lo c <br />Geologist: 4brokAn.e.-..A SreArvadrp <br />Public Water System Onsite: . D Yes 0No <br />Domestic Well Onsite: 0 Yes ENo <br /> <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: LI Yes LINo <br />SPOILS <br />Contamination Noted: 0 Yes El No <br />If yes, spoils storage Location: <br />Covered: E Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 0 <br />Grout Material: r‘e4A-- <br />Gallons of Grout Used: --rf5 - ) <br />OWell Installation DWell Destruction <br />El Boring Installation RISTing Destruction <br />METHOD USED <br />OPressure Grout 1110ver Drill <br />R<avity 0Tremie 00ther: <br />Water <br />gallons <br />Cement 47th <br />Bags <br />Water <br />gallons <br />Cement 94th <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest 4 Bags <br />2.5 s 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 />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes 11:INo <br />To: <br />To: <br />To: <br />To: <br />MATER1ALS/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 />Bentonitefeement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb 2.82 4.7 <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br />From: <br />10/16/2017 <br />1868 E. Hazelton Avenue! Stockton, California 95205 I T . 209 468-3420i F 209 464-0138 I www.sicehd.com