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COUNTY— <br />Greatness groves here. <br />SANdOAQUIP E.„ Environme ii Health Department <br />COMPLETION LI Stove Pipe <br />casing <br />height <br />CFURZTY-BOX <br />COMPLET19N <br />OChristie Box <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 7 1 Inspector: <br />Facility A d ress )0 .7 5 _ <br />Well Ad ress: <br />Wp# (,S9 ejt_svelitt: 24 <br />Soil <br />• <br />Soil Boring#: p <br />Drilling Company: Pe.A...,_62/4—f_ <br />Driller Onsite: c <br />Consultant: <br />Geologist: <br />Public Water System Onsite: 0 Yes 0 No <br />Domestic Well Onsite: Yes LINo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />1Viethod: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: r <br />Grout Material: <br />Gallons of Grout Used: <br />El Well Installation EWell Destruction <br />0 Boring Installation rf4<r.ing Destruction <br />METHOD USED <br />EPressure Grout ElOver Drill <br />LI Gravity iTremie 00ther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest #Bags <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 40 8 40 80 8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 1:1 Yes LIN° <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <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 />Yes 111No <br />0 Yes RN o <br />0 Yes El No <br />10/16/2017 <br />1868 E. Hazelton Avenue Stockton, California 95205 f 1 209 468-3420 I F 209 464-0138 I, www.sicehd.com