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SANAAQUIN - <br />•• COUNTY <br />Greatness grows here. <br />Environmei..d1 Health Department <br />Inspector: <br />CI Yes Domestic Well Onsite: <br />If yes, location and distance: <br />El Other: <br />El Well Installation El Well Destruction <br />111Boring Installation DBoring Destruction <br />METHOD USED <br />li1Pressure Grout DOver Drill <br />EGravity XTremie <br />Date: <br />Facility Address:/ <br />Well Address: <br />Public Water System Onsite: fl Yes <br />Drilling Company: <br />Driller Onsite: <br />/(.9 <br />2 41 <br />A n5 <br />WP# Well#: <br />Consultant: <br />Geologist: L.1J9( <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Soil Boring#:(Fr <br />Verified Chain of Custod <br />SPOILS <br />Contamination ted: <br />If yes, sp s storage Location: <br />Covere Yes ON° <br />If es, material: <br />G OUTING or DESTRUCTION Total Depth: <br />A.4-6 1 <br />Grout Material: Wr...-AT' <br />eiv <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # Bags <br />2.5 5 10 1 <br />5 10 20 2 <br />7.5 <br />.5....1:1 <br />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 />Total Depth: <br />Drilling Rig Type: <br />COMPLETION El Stove Pipe DChristie Box <br />casing <br />height <br />cFnari-pox <br />COMPLETION <br />Min 2" Annular EHD Seal Veilfied: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />ID Yes El N o <br />To: <br />To: <br />To: <br />To: <br />From: <br />From: <br />From: <br />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 />Depth to Water: <br />Gallons of Grout Used: <br />1868 E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />Monitoring Well/Soil Boring Inspection Report <br />CONSTRUCTION <br />Z:rY-2-674 <br />El Yes EINo <br />Yes LINo