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casing IT height <br />ABOVE-GROUND <br />COM2LETION <br />11 <br />Environmer Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 21 Inspector: <br />Facility a ddress: C.32ti+td or A-141 <br />Well Address: <br />WP# f,fP(TO'g 0 ir / Well#: <br />Soil Boring#: _S 6,5 7 j e 1 514 <br />Drilling Company: <br />Driller Onsite: Onsite: <br />Consultant: <br />Geologist: <br />Public Water Sys em Onsite: El Yes ON° <br />Domestic Well Onsite: <br /> <br />0 Yes DNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: D Yes ONo <br />SPOILS <br />Contamination Noted: LI Yes DNa <br />If yes, spoils storage Location: <br />Covered: 0 Yes EINo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: I U f <br />Depth to Water: <br />Grout Material: We-0-4— <br />Gallons of Grout Used: .g / <br />1 2 /1 " <br />0Well Installation DWell Destruction <br />IIIBoring Installation el‹.--ing Destruction <br />METHOD USED <br />OPressure Grout 00ver Drill <br />Cl Gravity Olcemie 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 ttBags <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: 111 Yes LINo <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: • To: <br />Grout From: To: <br />COMPLETION El Stove Pipe EChristie Box <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 />34 <br />1868 E. Hazelto <br />10/16/2017 <br />Avenue Stockton, California-95205 1 T 209 468-3420 I F 209 464-0138 I www.sicehd.com