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El Stove Pipe COMPLETION lilChristie Box Yes No Public Water System Onsite: <br />Yes ON° Domestic Well Onsite: <br />Yes 0 N o Verified Chain of Custody: <br />SPOILS <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2- 2-2., Inspector: <br />Facility A dress: jg -Por doh <br />Well Address: <br />vvp# DO L? Mz3 <br />Soil Boring#: Se, 2 <br />Drilling Company: j nagy <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes ILINo <br />To: <br />To: <br />To: <br />To: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: 0 Yes 0No <br />If yes, spoils storage Location: <br />Covered: Li Yes 0 No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:' <br />Depth to Water: <br />Grout Material: (V al- Ceivtilf <br />1 " <br />LiWell Installation 0 Well Destruction <br />0Boring Installation oring Destruction <br />METHOD USED <br />EPressure Grout DOver Drill <br />0 Gravity kTremie LI Other: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 941b <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 />casing <br />height <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 />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 <br />Well#: <br />C-AA. (ne 0 <br />5u*4-, <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />Gallons of Grout Used: <br />ABOVE-GROUND <br />COMPLETION CHR1STY-8OX <br />COMPLETION <br />--COUNTY <br />0 '` Greatness grows her ,' <br />SAN JOAQUIN Environmental Health Department <br />From: <br />From: <br />From: <br />From: