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SANAAQUIN <br />COUNTY <br /> Environmer Health Department <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />LIlYes LINo Verified Chain of Custody: <br />SPOILS <br />IL <br />Contamination Noted: El Yes ON° <br />If yes, spoils storage Location: <br />Covered: E Yes E No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 171 1./S' 3 <br />Depth to Water: <br />Grout Material: v\cAls" CiA,Auvd). <br />Gallons of Grout Used: "L-C. Lo <br />111Well Installation 111 Well Destruction <br />Date: qi7x,) Inspector:L. ,A4.4"1"1\ <br />Facility Address: 7.42S-7 <br />Well Address: 2.0 0 < CA ithrcioPL, <br />wP# 01.3$ (o14 Well#: <br />Soil Boring#: C.-en? kzA -‘,11 a-3 <br />Drilling Company: <br />Driller Onsite: <br />iir.Annr-vva."-"-cAr-krA <br />Public Water System Onsite: 111 Yes DNo <br />Domestic Well Onsite: El Yes IIINo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />LI Boring Installation L‘ring Destruction <br />METHOD USED <br />IIIPressure Grout DOver Drill <br />11"6<avity R'<emie 1110ther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest SI 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 5 <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 />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes ON° <br />To: <br />To: <br />To: <br />To: <br />COMPLETION El Stove Pipe <br />casing <br />height <br />DChristie Box <br />CA-SISTi=130X <br />COMPLETION <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <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 />Consultant: <br />Geologist: <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com