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iro Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />CONSTRUCTION <br />tfr-i° ick- tAc tAkr) <br />T <br />Drilling Rig Tvre: <br />otal Depth: <br />°t <br />in 2" Ann9ar EHD Verified: Yes LINo°' b• utiCpt WU et <br />From: <br />From: <br />From: <br />From: <br />kft6 OseW"I tyk. <br />To: <br />To: <br />To: <br />To: <br />‘P‘Wkrli <br />casing <br />height <br />ABOVE-GROUND <br />COMPLETION CHRISTY-BOX <br />COMPLETION <br />COMPLETION LI Stove Pipe OChristie Box <br />Ground Surface <br />grout <br />_ft <br />stoned <br />secton <br />c,L 5',51 <br /> ft. ft <br />SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Well Address: <br />WP # 0041,90 Well#: <br />Soil Boring#: —t4 biptgstfrea elyytved 8 <br />Drilling Company: 65 V-- <br />Driller Onsite: <br />Consultant: ,e612- fissocktfe5 <br />Geologist: —1010e,A <br />Date:2 Inspector: 56, rut-5 <br />Facility A dress:?. 2 00 0* (POO birici3e <br />Public Water System Onsite: LI Yes 0 N o <br />Domestic Well Onsite: CI Yes El No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br /> <br />El Yes El N o <br />SPOILS <br />Contamination Noted: 0 Yes El No <br />If yes, spoils storage Location: <br />Covered: 0 Yes uNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 121 <br />Depth to Water: M 0.4A-"'et. <br />Grout Material: lAect.:\ 001"421k4- <br />Gallons of Grout Used: 10 MATERIALS/DEVELOPMENT <br />Casing Type: <br />0 Well Installation 0 Well Destruction <br />LI Boring InstallationXBoring Destruction <br />METHOD USED <br />D Pressure Grout ElOver Drill <br />IAGravity LiTremie ElOther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest flags Thickest Thinnest gs <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 />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