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Total Depth: <br />Drilling Rig Type: <br />COMPLETION 0 Stove Pipe LIChristie Box <br />casing <br />height <br />CHAISTY-pOX <br />COMPLETION <br />0No EHD Seal Verified: <br />LC: <br />From: <br />From: <br />From: <br />From: <br />Ic ' <br />g'Yes <br />To: <br />To: <br />To: <br />To: <br />cCAMUn <br />Filter Pack <br />Bentonite <br />Grout <br />".9 '‘," <br />,4111SW.2", <br />ikrpoc‘' <br />SAN JOAQUI; <br />COUNTY <br />Greatness grows herr <br />Environmei.Lal Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: I, <br />Facility Address. / <br />Well Address: <br />W P# 1,-147 01) 3 <br />Soil Boring#: <br />/ Inspector: Yci <br />Went „S "2-- <br />-r r <br />Consultant: t1 i LhA.j4V46-•- <br />Drilling Company: <br />Driller Onsite: <br /> _Loft. D <br />Geologist: <br />Public Water System Onsite: 0 Yes El No <br />Domestic Well Onsite: <br /> 1:1 Yes ON° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes 0No <br />SPOILS <br />Contamination Noted: 0 Yes 111No <br />If yes, spoils storage Location: <br />Covered: LIYes El N o <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: / <br />E Well Installation 214Jell Destruction <br />El Boring Installation LI Boring Destruction <br />METHOD USED <br />0Pressure Grout 00ver Drill <br />V(Gravity 0Tremie 00ther: <br />Water <br />gallons <br />Cement 47 lb <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest flags Thickest Thinnest fl ags <br />2.5 5 1 s 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 40 8 40 80 8 <br />CONSTRUCTION <br />MATERIALS/DEVELOPMENT <br />Casing Type: 1 t'" <br />Blank .1 Feet Screen <br />Slot Size: <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 />Feet <br />Bags of Cement: <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com