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Min 2" Annular EHD Seal Verified: <br />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <br />COMPLETION El Stove Pipe <br />El Yes fiNo <br />To: <br />To: <br />To: <br />To: <br />lilChristie Box <br />casing <br />height <br />. _ <br />ABO VE -G ROUND <br />CO hAP LET 10 N C.HR ISTY-B0 X <br />CCfv1PLETICN <br /> ft <br />(I <br />SAN JOAQUIN <br />.1.1.11114•''-`i COUNTY <br />.1LIFos,1, G reatness grows iieii <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: \ Inspector: cLei c).--A CONSTRUCTION <br />Facility Address: 22. I Pi <br />Well Address: t W e;y.-+ <br />wp#OO Well#: SVC' 0 Li Total Depth: <br />Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: 1°:-;f-C-11-/-r- S-er2—; <br />Driller Onsite: V/4 <br />'Fez-- Consultant: vi 14 cl,,(-9 4) <br />Geologist: <br />Public Water System Onsite: El Yes El No <br />Domestic Well Onsite: n Yes n No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: III Yes nNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:2 <br />Depth to Water: ta ork-Lvu44_ ce4rtar,_t_ <br />Gallons of Grout Used: "- VC <br />LI Well Installation Destruction <br />nBoring Installation nBorin g Destruction <br />METHOD USED <br />El Pressure Grou Over Drill <br />POALV— <br />Tremie ElOther: <br />Yes ON° <br />n Yes El No <br />Grout Material: <br />LI Gravity <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 />Cemen7lby <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest gBags 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 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 />6(7 ba <br />Or y (A/i fiuSY-44, 1,1 i/L: <br /> <br />4' 90 c/L-; 4-j ciCiLre <br />CoAll c1.4 litr- <br />yir°1^- lo L.470 H.o9 S10/16/2017 <br />1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-3420 I F 209 464-0138 I www.sicehd.com