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Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: LI Yes <br />Domestic Well Onsite: <br />If yes, location and distance: <br />El Yes <br /> <br />e - . <br />COMPLETION CI Stove Pipe <br />casing <br />height <br />EChristie Box <br />SANJOAQUIR <br />COUNTY <br />Greotness grows here. <br />Environmental Health Department <br />Well/Soil Boring Inspection Report <br />1-4/tAto'CoNSTRUCTION <br />ii Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Veiified: E Yes ENo <br />To: <br />To: <br />To: <br />To: <br />Monitoring <br />Date. Inspector: <br />Facility Address: I kto015 rz,r, <br />Well Address: <br />WP# Well#: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes EINo <br />SPOILS <br />Contamination Noted: E Yes ID No <br />If yes, spoils storage Location: <br />Covered: El Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 15y#.1 <br />Depth to Water: 4-4N‘ <br />Grout Material: A/VIT 6-6-444-gar <br />Gallons of Grout Used: <br />EWell Installation El Well Destruction <br />CI Boring Installation XBoring Destruction <br />METHOD USED <br />Pressure Grout EOver Drill <br />y Gravity <br /> ITremie El Other: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # Bags <br />2.5 0 5 19 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 />Screen Length From: <br />Filter Pack From: <br />Bentonite From: <br />Grout From: <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