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casing <br />height <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />ABOVE-GROUND <br />CX)MPLETION <br />_tt <br />slottad <br />CHRISTY-BOX <br />COMPLETION <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows here <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 0 i i <br /> <br />Inspector:c-S( 4 Cid CONSTRUCTION <br />0-- Lt(rA Facility Address: 1 , CY( -14! _3 • <br />Well Address: Total Depth: <br />WP# Well#: <br />Soil Boring#: Cri -1 C Pt-3 3 <br />Drilling Company: i6kbc-r/ - <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />1-7 /v6 eo <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes Ell No <br />Screen Length From: To: <br />Filter Pack <br /> <br />From: To: <br />Bentonite From: To: <br />Grout <br /> <br />From: To: <br />Public Water System Onsite: Ill Yes II No COMPLETION El Stove Pipe lilChristie Box <br /> <br />Domestic Well Onsite: El Yes ElNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes li1No <br />SPOILS <br />Contamination Noted: El Yes ON° <br />If yes, spoils storage Location: <br />Covered: El Yes 111 No <br />If yes, material: <br />/00 7/ /01)) ad 1 GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: 11 4 çe-s4 <br />Gallons of Grout Used: 160 1Z)) <br />CI Well Installation OWell Destruction <br />El Boring Installation alkoring Destruction <br />METHOD USED <br />EPressure Grout lilOver Drill <br />E Gravity <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest /*Bags 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 />Blank Feet Screen <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 />11\Tremie <br />Feet <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com