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CI Stove Pipe COMPLETION EIChristie Box <br />Date: <br />Facility Address: <br />Well Address: <br />WP# 00 <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: i CONSTRUCTION <br />Cr' <br />Total Depth: <br />Drilling Rig Type: Is"" <br />El Yes EINo <br />- WI/0MM <br />MISEMr <br />Min 2" Annular EHD Seal Verified: LI Yes DNo <br />To: <br />To: <br />To: <br />To: <br />Well#: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />casing <br />height <br />Al3OVE-GROUND <br />COMPLETION CHPUSTY-BOX <br />COMPLETION <br />Ground Surtace <br />to <br />slottad <br />saclon <br />gravel pat <br /> ft. ft. <br />(β€”°, SAN JOAQUIN .i.,tiβ€ž,:.- watrao)β€” COUNTY <br />it,'ureatness grows here <br />Environmental Health Department <br />Domestic Well Onsite: Yes CINo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: D Yes ON° <br />SPOILS <br />Contamination Noted: LI Yes ENo <br />If yes, spoils storage Location: <br />Covered: EYes DNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:25 -2/-6( a <br />Depth to Water: nOn-e-- f <br />Grout Material: neAt C 114,1 <br />Gallons of Grout Used: '-β€˜"I '3 0 <br />111 Well Installation OWell Destruction <br />OBoring Installation 111Boring Destruction <br />METHOD USED <br />DPressure Grout DOver Drill <br />'*ravity OTremie El Other: <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 />Water <br />gallons <br />Ceme 47 lb <br />Ba <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest flags Thickest Thinnest flags <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 />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 />rl 2 14 621) <br />1868 L. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com