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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: LI Yes 0No <br />To: <br />To: <br />To: <br />To: <br />COMPLETION D Stove Pipe <br />casing <br />height <br />EChristie Box <br />CHRIS1Y-p0X <br />COMPLETION <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br /> <br />SAN JOAQUIN Environmel ' Health Department <br />' <br />COUNTY <br />Greatness grows here <br /> <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 111ZA II 7 Inspector: I--47v CONSTRUCTION <br />Facility Address: (kV <br />Well Address: <br /> <br />WP# <br />Soil Boring#: <br />Drilling Company: tict, i•J <br />Driller Onsite: <br />Consultant: C-5 ebu..-at <br />Geologist: lannelle-e..A.-) <br />Public Water System Onsite: 0 Yes El No <br />Domestic Well Onsite: 0 Yes ON° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes E] No <br />SPOILS <br />Contamination Noted: 0 Yes 0No <br />If yes, spoils storage Location: <br />Covered: 0 Yes 0No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: 1- :C <br />Grout Material: tre,,,A-- a.,-4- <br />Gallons of Grout Used:13) <br />DWell Installation ell Destruction <br />El Boring Installation El Boring Destruction <br />METHOD USED <br />ElPressure Grout .'6'er Drill <br />r<rnie ClOther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 94110 <br />Bags <br />Thickest Thinnest AiBags Thickest Thinnest 8Bags <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 />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 />Wel 1#: Vf,v4-1 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.corn