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SANAAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <br />Domestic Well Onsite: <br />Public Water System Onsite: <br /> d Yes 0No <br />0 Yes LIN° <br />\ Gallons of Grout Used: <br />111 Well Installation OWell Destruction <br />Boring Destruction 0 Boring Installation <br />METHOD USED <br />0 Gravity Tremie 00ther: <br />Monitoring Well/Soil Boring Inspection Report <br />Date:1- IS 11....fro'LA Inspector: CS)A5\..E\ CONSTRUCTION <br />Facility Address: \\"V3 <br />Well Address: <br />WP# k-\\ <br />Soil Boring#: c2,. \ - <br />Drilling Company: 5 <br />Driller Onsite: <br />Consultant: <br />Geologist: -\--c_A-N, <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes 0No <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />If yes, location and distance: <br />SAMPLING /. <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes 0No <br />SPOILS <br />Contamination Noted: El Yes 14No <br />If yes, spoils storage Location: <br />Covered: 0 Yes dNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:-2 <br />Depth to Water: <br />Grout Material: <br />0Pressure Grout 00ver Drill <br />Water <br />gallons <br />Thickest Thinnest <br />Cement 47W <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />/*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 />COMPLETION 0 Stove Pipe 0Christie Box <br />casing <br />height <br />COMPLETION <br />ft. <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 T 209 468-3420 I F 209 464-0138 I www.sicehd.com