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Min 2" Annular EHD Seal Verified: CI Yes El N o <br />To: <br />To: <br />To: <br />To: <br />COMPLETION El Stove Pipe <br />casing <br />height <br />Ii1Christie Box <br />C14RISTY-80X <br />COMPLETION <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />SAN.DJOAQUIN Environmental Health Department <br />COUNTY <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 013/ tg Inspector: 1--or CONSTRUCTION <br />Facility Address: 2.445. v.) el....A-4v-- <br />Well Address: <br />WP# 55C2-ep <br /> <br />Total Depth: <br />Drilling Rig Type: <br /> <br />Well#: - <br /> <br />Soil Boring#: <br />Drilling Company: Vtm <br />Driller Onsite: VThrtuf.itt-- <br />Consultant: Wwilt 214.1rD <br />Geologist: Pr....dertAO <br />Public Water System Onsite: LI Yes El No <br />Domestic Well Onsite: LI Yes LIN0 <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: CI Yes ON° <br />SPOILS <br />Contamination Noted: LI Yes El No <br />If yes, spoils storage Location: <br />Covered: III Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 15& <br />Depth to Water: ( <br />Grout Material: hi4,A cAnrAv...Ar <br />Gallons of Grout Used: I O., <br />CI Well Installation M1Vell Destruction <br />CI Boring Installation III Boring Destruction <br />METHOD USED <br />El Pressure Grout 2C<er Drill <br />El Gravity mie DOther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest ttBags Thickest Thinnest 4Bags <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 />10/16/2017 <br />460 10 5 <br />1868 E. Hazelton Avenue r Stockn, evaTifornia 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com