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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 111 Yes DNo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION El Stove Pipe <br />casing <br />height <br />IIIChristie Box <br />cHnisre-sox <br />co..4PLE11oN <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />SAN JOAQUIN <br />COUNTY-- <br />C,reatness grows <br />Environmer1 Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ct 1 %Ai iv I Inspector: L-4Nr- INA's'n\ <br />Facility Address:Soc) <br />Well Address:21,1, 5 • Se+, 3-S1teru,, 63"-- <br />WP# 003D0 cto Well#: <br />Soil Bo ri ng#: - °VOA C91-1 •• <br />Drilling Company: Lrve_y..) C <br />Driller Onsite: Onsite: <br />Consultant: gchirx.,?s,--1 <br />Geologist: CA.ra.." <br />Public Water System Onsite: El Yes IIINo <br />Domestic Well Onsite: El Yes El N o <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes LI No <br />SPOILS <br />Contamination Noted: I=1 Yes LIINo <br />If yes, spoils storage Location: <br />Covered: El Yes EINo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: IXA <br />Grout Material: 64....15- Csew-4 <br />Gallons of Grout Used: 13-ci 1.1Q <br />31 ) <br />OWell Installation ClWell Destruction <br />1=I Boring Installation Rforing Destruction <br />METHOD USED <br />OPressure Grout 1110ver Drill <br />LI Gravity 2K-emie 00ther: <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 <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 s <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 />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 />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com