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Yes 1E1 N o Public Water System Onsite: <br />El Yes 111No Domestic Well Onsite: <br />Yes IIINo Verified Chain of Custody: <br />SPOILS <br />COMPLETION El Stove Pipe El Christie Box <br />Screen Feet Blank 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 />Monitoring Well/Soil Boring Inspection Report <br />Inspector: SA- t CO) CONSTRUCTION <br />SAN JOAQUIN <br />Ltlf COUNTY <br />• G,eut rIess grows het r <br />Date: <br />Facility Address: <br />WP# C) 6 lreit V <br />AJa <br />ell#: <br />te:—Iy Well Address: <br />1) i <br />Soil Boring#: t - CPT-- ) 77 <br />Drilling Company: Li L.)„,\( /- <br />Driller Onsite: CAt <br />Consultant: <br />Geologist: V v cuLcit\-0, <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: LI Yes lii No <br />If yes, spoils storage Location: <br />Covered: 111 Yes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />El Well Installation LI Well Destruction <br />\O) <br />Water <br />gallons <br />Cement 47 lb <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 />Environmental Health Department <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes ID No <br />To: <br />To: <br />To: <br />To: <br />grout <br /> ft <br /> ft <br />_ft <br />slotted <br />sacden <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />casing <br />height <br />CtiRISTY-BOX <br />COMPLETION <br /> Ground Sudan + <br />From: <br />From: <br />From: <br />From: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <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 />5C(55 <br />4 <br />METHOD USED <br />111Pressure Grout 1110ver Drill <br />LI Gravity ETremie 1110ther: <br />El Boring Installation OBoring Destruction \to <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