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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes 0No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />COMPLETION El Stove Pipe El Christie Box <br />casing <br />height <br />A130--VE-oROUND <br />COMPLETION <br /> <br />COMPLETION <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Screen <br /> <br />Feet <br /> <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 <br />Bentonite per 94 lb <br />1.41 2.47 <br />2.82 4.7 <br />SANdOAQUIN <br />COU N TY—, <br />Greo Loess grcw.F. hue. <br />Environmen' Health Department <br />Date/ <br />Facility Addre <br />Well Address: <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: ri CONSTRUCTION <br />s: )6, ytD ji. D1/4a- <br />SA <br />vvp# pip ot, 376 7.-0 Well#:44Q24010r • <br />Soil Boring#: <br />Drilling Company: ki 4/9(7 it A.2.7{ <br />Driller Onsite: <br />Consultant: cz, <br />Geologist: ;Inn .00 „Donn <br />Public Water System Onsite: <br />0 Yes 0No <br />Domestic Well Onsite: <br />0 Yes []No <br />If yes, location and distance: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTIONqtal Depth:5,6 <br />Depth to Water: t 3 <br />Grout Material: flo..k.k- <br />Gallons of Grout Used: <br />0Boring Installation <br />bring Destruction <br />METHOD USED <br />LI Pressure Grout ver Drill <br />0 Gravity <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 1 5 10 1 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 />SAMPLING <br />Holding Temperature: <br />Method: <br />El Yes LINo <br />0 Yes 0No <br />ir <br />OWell Installation ell. Destruction <br />[it<:emie El Other: <br />10/16/2017 <br />/7."ft <br />, California o5205 f T 209 468-3420 I F 209 464-0138 T, www.sicehd.com <br />188 E.E. Hazelton Avenue f o