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1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />SANAAQUIN <br />--COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />LI Stove Pipe COMPLETION LIChristie Box Public Water System Onsite: LI Yes LIN0 <br />Feet Blank Feet Screen <br />Slot Size: <br />Monitoring Well/Soil Boring Inspection Report <br />Date: "f//24 Inspe tor: /c, 4 • CONSTRUCTION <br />Facility Address: .--1 . . P-21 in..e- <br />Well ddress. ,-- nee at 00-16-W(7.-16-y <br />WP Li 1 weli4t:51/e- 0 k ' <br />Soil Boring: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />To: <br />Domestic Well Onsite: El Yes LIN0 <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: LI Yes El No <br />SPOILS <br />Contamination Noted: LI Yes 111 o <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:25 Lis-14 <br />Depth to Water: 5 1- <br />El Yes LINo <br /> J._ <br />Grout Material: kie4v_ <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />EWeII Installation El Well Destruction <br />CI Boring Installation OBoring Destruction <br />METHOD USED <br />OPressure Grout %VrOver Drill <br />El Gravity KTremi DOther: <br />Water <br />gallons <br />Cemen017 IV <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest It Bags Thickest Thinnest 4 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 />s6 <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 />casing <br />height <br />Ground Sudan <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />LI Yes EINo <br />To: <br />To: <br />To: <br />From: <br />From: <br />From: <br />From: