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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes ONo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION Stove Pipe DChristie Box <br /> <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />casing <br />height <br />-- <br />ABOVE-GROUND <br />CO MP LETIO N <br /> <br />CHR1STY-BOX <br />COMPLETION <br />_ft <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows here <br />Environmental Health Department <br />or\ cs;)-e., 2:(10friA-fo <br />Monitoring Well/Soil Boring Inspection Report <br />Date: \ 71 Inspector: <br />Facility Address: SD E. Loath() <br />Well Address: <br />WP# 00 (42:(Li We11#: <br />Soil Boring#: 136 ),(35 1 64 <br />Drilling Company: ltrea(Or\-- <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: LI Yes ON° <br />Domestic Well Onsite: D Yes EINo <br /> <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: D Yes D No <br />SPOILS <br />Contamination Noted: 0 Yes IIINo <br />If yes, spoils storage Location: <br />Covered: 0 Yes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 114. <br />Depth to Water: t E"--1 — <br />Grout Material: k....\P_Ok <br />Gallons of Grout Used: '‘-• 0 t <br />DWell Installation 0Well D . <br />) <br />struction <br />DBoring Installation EBoring Destruction <br />METHOD USED <br />Pressure Grout DOver Drill <br />Gravity ETremie pOther: <br />Water <br />gallons <br />Cernint 471b <br />( Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest ags 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 />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 />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com