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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes ON° <br />To: <br />To: <br />To: <br />To: <br />COMPLETION 0 Stove Pipe lilChristie Box <br />grout <br />ft <br /> ft <br />gravel pack <br />ft. <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />ABOVEGROUND <br />COtv'PLETION <br />casing <br />height <br />CHRSSTY-BOX <br />COMPI_ETION <br />Ground Surface <br />From: <br />From: <br />From: <br />From: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Screen Feet <br />oxier. <br />. Type of Method: <br />(r,SANIJOAQUIN COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: CONSTRUCTION <br />Facility Addre <br />Well Address: <br />WP# k5 <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Well#: <br />Public Water System Onsite: 0 Yes lilNo <br />Domestic Well Onsite: Yes EINo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes 0 No <br />SPOILS <br />Contamination Noted: 0 Yes 0 No <br />If yes, spoils storage Location: <br />Covered: LIYes 0 N o <br />If yes, material: <br />( <br />GROUTING or DESTRUCTION Total Depth:_______ <br />Depth to Water: ty <br />Grout Material: ?Vat cleivvivt- - <br />Gallons of Grout Used: <br />0 Well Installation ElWell Destruction <br />0 Boring Installation on rig Destruction <br />METHOD USED <br />Pressure Grout lilOver Drill <br />El Gravity )81-Tremie DOther: <br />Water <br />gallons <br />,er nt 47 lb <br />Ba <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest 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 />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