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Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: Ill Yes EINo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION LI Stove Pipe Li Christie Box <br />casing <br />I height <br />ABOVE-GROUND <br />OOMPLETION <br />Ground Sulacir <br />ft. <br />fl <br />_ft <br />giwol pack <br /> ft. <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <br />SANAAQUIN <br />COUNTY— <br />Greatness grows here. <br />Environmei I Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Inspector: /4 <br />Ce-1---4'.•-k Pe."' 1e-4s/el <br />Date: <br />Facility Address: <br />Well AddrAss: <br />WP# 0-03 , 0% c WeII#: <br />Soil Boring#: ,S4 - c=il <br />Drilling Company: P-12A(,,cr <br />Driller Onsite: C.A.-C-4"C <br />Consultant: 6 <br />Geologist: '`,0 <br />Public Water System Onsite: 0 Yes 0 No <br />Domestic Well Onsite: 0 Yes LIN° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 0 Yes 0No <br />SPOILS <br />Contamination Noted: 0 Yes 0 No <br />If yes, spoils storage Location: <br />Covered: <br /> 0 Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: /0 <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: 3 <br />VVell Installation 0Well Destruction <br />0 Boring Installation lBo'ring Destruction <br />METHOD USED <br />Pressure Grout 00ver Drill <br />0 Gravity 121emie ClOther: <br /> <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94W <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 />CONSTRUCTION <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 />Bentoniteleement 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 />a avxv•e-Nr- <br />1868 E. Hazelton Avenue l Stockton, California 95205 T 209 468-3420 I F 209 464-0138 I vvww.sicehd.com