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Depth to Water: <br />Grout Material: <br />4 3 <br />?leo 6tnic4t <br />Gallons of Grout Used: <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: E Yes lilNo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION IE1 Stove Pipe <br />casing <br />height <br />Li Christie Box <br />CHRIST'-OX <br />COMPLETION <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />SAN p1040 U I ,6itka, .2) COUNTY <br />' Greatness grows here. <br />Enviromm .al Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: a_ 0. Inspector:774 I,-s.So 71:55,fri <br />Facility Address: frit) 14a <br />Well Address: i <br />WP# Well#: <br />Soil Boring#: 4.5 tija 4-er- Scj,,17_ <br />Drilling Company: CLA I*Lrrt Pi) S rret. <br />Driller Onsite: C 1 y 4-c r, <br />Consultant: Co Nof c <br />Geologist: 1, IA C <br />Public Water System Onsite: <br /> <br />LIIYes No <br />Domestic Well Onsite: <br /> <br />LiIYes No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes EN° <br />SPOILS <br />Contamination Noted: II Yes DNo <br />If yes, spoils storage Location: <br />Covered: E Yes LIINo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: Sk r <br />DWell Installation OWell Destruction <br />OBoring Installation Boring Destruction <br />METHOD USED <br />EPressure Grout lilOver Drill <br />Gravity ATremie 1110ther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest 4 Bags <br />2.5 e ' D ci) s 10 1 <br />s 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 /2 017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com