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SANAAQUIN Environment.... Health Department <br />i COUNTY <br />\10,00_30,- Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 611_51iX Inspector: 1.--01" X k V-6 <br />Facility Address: 17,`AS— <br />Well Address: <br />WP# 0036o1M Well#: <br />Soil Boring#: <br />Drilling Company: 4 <br />‘115 ki On I I ir,D <br />Driller Onsite: <br />Consultant: (,-v-v../..k <br />Geologist: A-1,...Art in) <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes IIINo <br />From: To: <br />From: To: <br />From: To: <br />From: To: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />Public Water System Onsite: 0 Yes EINo COMPLETION 0 Stove Pipe 0Christie Box <br /> <br />Domestic Well Onsite: LI Yes 0No <br />If yes, location and distance: <br />casing <br />height <br /> <br />SAMPLING <br />Holding Temperature: <br />Method: <br /> <br />CHRISTY-BOX <br />COMPLETION <br /> <br />Ground Surface <br /> <br />Screening Method: <br />Verified Chain of Custody: 0 Yes El No <br />SPOILS <br />Contamination Noted: 0 Yes 0No <br />If yes, spoils storage Location: <br />Covered: El Yes EN° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: I'Vel <br />Grout Material: (.—k <br />Gallons of Grout Used: <br />ElWell Installation inCVell Destruction <br />Boring Installation 0 Boring Destruction <br />METHOD USED <br />Pressure Grout gever Drill <br />Gravity Eriremie DOther: <br />Water <br />gallons <br />Cernent471b <br />Bags <br />Water <br />gallons <br />Cennent941b <br />Bags <br />Thickest Thinnest //Bags Thickest Thinnest flags <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 s 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 />10/16/2017 <br />tot- <br />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-34201 F 209 464-0138 I www.sicehd.com