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SAN :JOAQUIN <br />tilde -COUNTY <br />Greotness grows here <br />Q00, o pow\ <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 20 4pector: )11%1 CONSTRUCTION <br />Facility Address: 2- CC 4 0 L..00yvi c5tak-too . <br />Well Address: <br />WP# S („0 Well#: <br />Soil Boring#: t rek <br />Drilling Company. WO,Si"La- G)(c) 0 fat WV) <br />Driller Onsite: <br />Geologist: <br />U,) 12-5 COUS4 S Consultant: <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: El Yes 171N0 <br />To: <br />To: <br />To: <br />To: <br />" iDEt.-F"/On <br />94-1vv\ I StArk erv <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br />From: <br />Public Water System Onsite: El Yes EINo COMPLETION D Stove Pipe OChristie Box <br /> <br />Domestic Well Onsite: D Yes lilNo <br />If yes, location and distance: <br />casing <br />height <br /> <br />SAMPLING <br />Holding Temperature: <br />Method: <br /> <br />ABOVE-GROUND <br />COMPLETION <br /> <br />CHRLSTY-BOX <br />COMPLETION <br /> <br />Ground Surtacs <br /> <br />Screening Method: <br />Verified Chain of Custody: Yes ON° <br />SPOILS <br />Contamination Noted: 0 Yes ON° <br />If yes, spoils storage Location: <br />Covered: 0 Yes ON° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />DepthDepth to Water: NC) <br />Grout Material: fle.a.-\- C,PitYN24- <br />Gallons of Grout Used: <br />OWell Installation EWell Destruction <br />lilBoring Installation KIBoring Destruction <br />METHOD USED <br />OPressure Grout ClOver Drill <br />21. Gravity OTremie <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest g Bags Thickest Thinnest g Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 15 ,..-/-*- 3 1.--- 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 />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 j F 209 464-0138 I www.sicehd.com