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111 Christie Box COMPLETION CI Stove Pipe <br />casing <br />height <br />CHFUSTY-BOX <br />CCMPLETION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: CI Yes ElNo <br />To: <br />To: <br />To: <br />To: <br />Ground Sulacs <br />grout <br />ft <br />ft. <br />-ft. <br />slotted <br />sacton <br />ft <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />SAN JOAQUIN <br />COUNTY <br />Greutness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Lc Date: a all Inspector: CNA <br />Facility Address: 2("S plezrzli L4rie <br />Well Address: <br />volt 004icsile <br /> <br />Well#: <br />Soil Boring#: <br />Drilling Company: -I- rJek./ (vet) Exploit/)'101 <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: El Yes 'No <br />Domestic Well Onsite: Yes !'No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: LI Yes ENo <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Locatio <br />Covered: ElYes 1=INo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: IS <br />Depth to Water: %"-- <br />Grout Material: Nee& Cepterlf <br />Gallons of Grout Used: <br />El Well Installation El Well Destruction <br />lilBoring Installation ABoring Destruction <br />METHOD USED <br />EPressure Grout ElOver Drill <br />CI Gravity ETremie 00ther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94W <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest rtBags <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 />CONSTRUCTION <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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com