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SAN JOAQUIN <br />C U NT Y— <br />Greoiness grows here <br />ea$1.11g <br />height <br />CHFIST'40X " <br />COMPLET1pN <br />Grairozi Si.olace <br />grail <br />ft. <br />Environmentz ealth Department <br />Monitoring Well/Soil Boring inspection Report <br />Date: Inspector: 1—lov- )(iv <br />Facility Address: 1147 <br />CONSTRUCTION <br />Well Address: <br />WP# Qb AI 104 Well#: <br />Soil Boring#: <br />Drilling Company: C_...te...01.c. <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: 0 Yes 111No <br />Domestic Well Onsite: 0 Yes 0No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br /> <br />Screening Method: <br />Verified Chain of Custody: <br />0 Yes 0No <br />SPOILS <br />Contamination Noted: 0 Yes 0No <br />If yes, spoils storage Location: <br />Covered: 0 Yes 0No <br /> <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 247 <br />Depth to Water:3 <br />Grout Material: <br />Gallons of Grout Used: ip <br /> <br />. 0Well Installation 0,Well Destruction <br />0Boring Installation P"(oring Destruction <br />METHOD USED <br />0Pressure Grout 1110ver Drill <br />R'<avity GZemie CiOther: <br />Water <br />gallons <br />Cement 47 lb <br />Bags <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest 4 Bags Thickest Thinnest 4 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 />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes ONlo <br />To: <br />To: <br />To: <br />To: <br />COMPLETION 0 Stove Pipe 0Christie Box <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br /> <br />BentonitelCement Mix 3% Mix 5% Mix <br />Bentonite per 47 lb 1.41 2.47 <br />Bentonite per 94 lb , 2.82 4.7 <br />Screen Length From: <br />Filter Pack <br />From: <br />Bentonite From: <br />Grout From: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />10/16/2017 <br />1868 E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com