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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: D Yes EINo <br />To: <br />To: <br />To: <br />To: <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />COMPLETION DI Stove Pipe <br />casing <br />height <br />EIChristie Box <br />ABOVE-GROUND <br />COMPLETION <br />_ft <br />slottad <br />sacten <br />ft. <br />SAW-JOAQUIN <br />—COUNTY ------ <br />Environmental Health Department <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Lt 5 I 22 Inspector: 1 <br />FUget m Facility A dress: C2-e) C . i <br />Well Address: <br />WP# OC)Lk7j4c19.- Well#: <br />Soil Boring#: '" I A, '2_ <br />Drilling Company: V <br />Driller Onsite: C\ L. 4t PrAiittOill <br />Consultant: V <br />Geologist: 1\-) C <br />xf <br />AC,131-a, <br />Public Water System Onsite: D Yes ON° <br />Domestic Well Onsite: 111 Yes ON° <br /> <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: U Yes IIINo <br />SPOILS <br />Contamination Noted: U Yes EN° <br />If yes, spoils storage Location: <br />Covered: Yes ONo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of of Grout Used: 50 40-4. <br />OWell Installation DWell Destruction <br />oring Destruction <br />,2;\ <br />D Pressure Grout 1110ver Drill <br />D Gravity remie DOther <br />Water <br />gallons <br />Cement 471b <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 1 <br />7.5 15 3 15 30 3 <br />10 20 4 20 ao 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 />CONSTRUCTION <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 />na,5 <br />D Boring Installation : <br />METHOD USED <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com