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10/16/2017 <br />1868 E. Hazelton Avenue [ Stockton, California 95205 i T 209 468-3420 F 209 464-0138 I www.sicehd.com <br />SAN JOAQUIN <br />COUNTY- Environment& qeallth Department <br />Yes EINo <br />Yes IiINo <br />Public Water System Onsite: <br />Domestic Well Onsite: <br />If yes, location and distance: <br />n Yes IENo Verified Chain of Custody: <br />SPOILS <br />Boring Destruction DBoring Installation <br />METHOD USED <br />Date: Inspector: LOY )() OA\ <br />Facility Address: -TAW 3 tz <br />Well Address: c <br />WP# 00 1(1641- Well#4101 <br />Soil Boring#: ,5esi <br />Drilling Company: <br />Driller Onsite: <br /> C-06 (PA ›orqM"- <br />Consultant: Qat-kV:et_ <br />Geologist: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: El Yes ONo <br />If yes, spoils storage Location: <br />Covered: 0 Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:204 <br />Depth to Water: ç4. <br />Grout Material: <br />Gallons of Grout Used: Lo5 <br />E7Well Installation 0Well Destruction <br />lEIPressure Grout lilOver Drill <br />l "Gravity Rtremie nOther: <br />Water <br />gallons <br />Cement 47 lb <br />Bags <br />Water <br />gallons <br />Cem ent 94 lb <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest 4 Bags <br />2,5 5 1 5 10 1 <br />s 1.0 2 10 20 2 <br />7,5 15 3 15 30 a <br />lo 20 4 20 40 4 <br />11,5 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 />I Boring Inspection Report <br />CONSTRUCTION <br />Total Depth:"Vilei, <br />Drilling Rig Type: <br />grasrsi pixis <br />Min 2" Annular END Seal Verified: <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />El Stove Pipe <br />ID Yes LIN° <br />To: <br />To:' <br />To: <br />To: <br />ClChristie Box <br />casi.rig <br />— 1029rwAreir P.2214 <br />\la k <br />CHFUST;e--10)4 <br />COMPLET1pN <br />04-mil-A Surface <br />• - <br />/ ft <br />in Lit '4 <br />-ft. <br />COMPLETION <br />alortad <br />tlocdon <br />grout <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 />Monitoring Well/Sol