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COMPLETION 0 Stove Pipe 0Christie Box <br />casing <br />height <br />clintsre-aox ' <br />COMPLET19N <br />SANAAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date:t \ \ Inspector: atisoityv, <br />Facility Address: \.(\.\ sqlcYks:S) <br />Well Address: j H's <br />WP# \. Well#: t\j/p., <br />Soil Boring#: <br />Drilling Company: N) <br />Driller Onsite: <br />Consultant: Pk.-; " <br />Geologist: <br />Public Water System Onsite: /4 Yes 0No <br />kr\sk•-•.-15-.-- <br />'Domest3c Well Onsite: kYes 0No <br /> <br />If yes, location and distance: l.iwQ1' <br />SAMPLING \--D J\r-, <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes 111No <br />SPOILS <br />Contamination Noted: 0 Yes [AN° <br />If yes, spoils storage Location: <br />Covered: 0 Yes EgNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:q, 0-% VQ, <br />Depth to Water: <br />Grout Material: Kc _c\-14c <br />Gallons of Grout Used: c-No4A <br />El Well Installation El Well Destruction <br />El Boring Installation 41Boring Destruction <br />METHOD USED <br />li1Pressure Grout 00ver Drill <br />tAGravity 0Tremie 00ther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest ItBags <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 <br />/i <br />20 40 4 <br />12.5 CZ \-?.., 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 />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes El No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />MATERIALS/DEVELOPMENT PV <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