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111 Yes EN° Domestic Well Onsite: <br />0 Yes IIINo Verified Chain of Custody: <br />SPOILS <br />VVP# ()CY-VIA() We11#: <br />Soil Boring#: '6S <br />Drilling Company: 1.1)0.1- Coekst- expb rcui tork Dv, <br />Driller Onsite: <br />Consultant: 5- LIA Thc <br />Geologist: ixAeAP ,t <br />Public Water System Onsite: Yes ON° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: El Yes ON° <br />If yes, spoils storage Location: <br />Covered: El Yes Ell N o <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: wakic • <br />Grout Material: k\2142_Cx..1/2 ct) ere <br />Gallons of Grout Used: <br />El Well Installation 111Well Destruction <br />lilBoring Installation ,IXI,Boring Destruction <br />METHOD USED <br />El Pressure Grout 1110ver Drill <br />V. Gravity ETremie DOther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <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 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Date: I I Inspectr:CONSTRUCTION <br />WAIL, )/11 Facility Address: '2:40 G VO <br />Well Address: <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 F 209 464-0138 I www.sicehd.com <br />casing <br />height <br />CHRISTY-BOX <br />COMPLETION <br />gravel pack <br />ft <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: CI Yes ON° <br />To: <br />To: <br />To: <br />To: <br />COMPLETION 111 Stove Pipe 111Christie Box <br />Grourod Surface <br />grout <br />ft <br /> ft <br />slotted <br />victon <br />ft. <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />SAN ,JOAQUIN <br />-- COUNTY <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Environmental Health Department <br />i <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen <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 />Feet