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SAN JOAQUIN <br />COUNTY— <br />Greutriess 9rOWS here. <br />Environmental Health Department <br />kiNo <br />LtNo <br />Public Water System Onsite: El Yes <br />Domestic Well Onsite: LI Yes <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Varial Inspector: ?(Pial14136 <br />Facility Address: acat alarck lame <br />Well Address: <br />WP # poLoiLir Well#: <br />Soil Boring#: I 3 <br />Drilling Company: CAI -NeV Geo CxploT4fier <br />Driller Onsite: <br />Consultant: &Nes— Victuf <br />Geologist: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: E Yes IIINo <br />SPOILS <br />Contamination Noted: El Yes E No <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 19.0 <br />Depth to Water: . <br />Grout Material: /4-01t (wt- <br />Gallons of Grout Used: <br />E Well Installation EWell Destruction <br />111 Boring Installation kBorin g Destruction <br />METHOD USED <br />El Pressure Grout ElOver Drill <br />El Gravity IVITremie 1:10ther: <br />Water <br />gallons <br />Cement 471b <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 ...m.- 25 0. 0110 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 />CONSTRUCTION <br />_fit <br />Wottad <br />secton <br />ft. <br />Total Depth: <br />Drilling Rig Type: <br />casing <br />height <br />CHRISTY-BOX <br />COMPLETION <br />Gnxind Surface <br />grout <br />wir <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />El Stove Pipe <br />E Yes E No <br />To: <br />To: <br />To: <br />To: <br />E Christie Box <br />ABOVE-GROUND <br />COtt,PLETION <br />ft <br />ft. <br />ft. <br />From: <br />From: <br />From: <br />From: <br />COMPLETION <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 95205 I T 209 468-3420 F 209 464-0138 I www.sicehd.com <br />Yes 111No <br />Feet