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CONSTRUCTION <br />Total Depth: <br />Drilling Rig Ty e: <br />casing <br />height <br />cHFusTi'-pox - <br />COMPLETIcN <br />bolt_ <br />`;‘•• cA,Atm-A-Itti <br />ft <br />stattad <br />a•cdan <br />ft <br />ft. <br />Gratird Surface <br />SAWDJOAQUIN <br />COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil <br />Date: I n Inspector: f7 JO IA-- <br />Facility /ddress: 7 <br />Well A dress: <br />WP# U e 60 1 S-3 Well#: <br />Soil Boring#: <br />Drilling Company: AAA:4. ( nr1 ("4,‘S <br />Driller Onsite: Jtkh <br />Consultant: .g3AA/1 <br />Geologist: <br />Public Water System Onsite: El Yes I=1No <br />Environme I Health Department <br />Boring Inspection Report <br />HD Seal Verified: 111 Yes 0No <br />From: 3 '7 ' To: Z.2 1 CowSwi 0 <br />From://to To: 7.-0.2 ' <br />From: `2„0 To: / 7 ' <br />From: I -7 1 To: <br />II4tove Pipe 0 Christie Box <br />Min 2" Annular E <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION <br />Domestic Well Onsite: 0 Yes Ii1No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes ONo <br />SPOILS <br />Contamination Noted: 0 Yes El No <br />If yes, spoils storage Location: <br />Covered: D Yes EINo <br />If yes, material: <br />GROUTING or DESTRUCTION Tital Depth: <br />Depth to Water: / <br />Grout Material: <br />Gallons of Grout Used: <br />Well Installation EWell Destruction <br />IIIBoring Installation El Boring Destruction <br />METHOD USED <br />111 Pressure Grout E0ver Drill <br />CI Gravity <br /> <br />er;mie <br />Water <br />gallons <br />Cennent471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest 1Bags Thickest Thinnest ttBags <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 AO 8 40 80 8 <br /> ft. I ft. <br />MATERIALS/DEVELOPMENT <br />Blank "1. li Feet e ki( Screen /_ç Feet <br />Slot Size: . 9,2— il...- <br />Bags of Cement: y <br />Bags Sand/Gravel: /0 <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 />so <br />gravai pacit <br />Casing Type: <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 F 209 464-0138 F. www.sicehd.com