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Total Depth: <br />Drilling Rig Type: <br />Mir'2" Annular EHD Seal Verified: LI Yes LINo <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION LI Stove Pipe EIChristie Box <br />ft. <br />casing <br />height <br />CHRISTY-50X <br />COMPLETION <br />Grotirxt Surface <br />grout <br />ft <br />ft <br />-ft <br />slotted <br />sacton <br />tt. <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 />SANAAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitorn Well/Soil Boring Inspection Report <br />14. \ „ <br />Date: 'e"/_k Inspector:___ <br />CONSTRUCTION _ • <br />Facility Address: \ <br />Well Address: <br />WP# *•>••• b o NA. -LA r.) <br />Soil Boring#: -3) <br />Drilling Company: \r\-t- <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: El Yes /No <br />Domestic Well Onsite: Yes El No <br />If yes, location and distance: \A 5 0 <br />SAMPLING Qi,to, <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes ON° <br />SPOILS <br />Contamination Noted: LI Yes No <br />If yes, spoils storage Location: <br />Covered: El Yes No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: Vall <br />Depth to Water: 0 I c\ <br />Grout Material: NJ <br />Gallons of Grout Used: tSe0. <br />El Well Installation El Well Destruction <br />LI Boring Installation 'Boring Destruction <br />METHOD USED <br />El Pressure Grout IllOver Drill <br />1Gravity ILITremie ElOther: <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 1 5 1 <br />5 6: <br />10 <br />a 20) 10 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 />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 1 209 468-3420 F 209 464-0138 I www.sicehd.com