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COMPLETION CI Stove Pipe EChristie Box <br />Drilling Rig Type: <br />grout <br />—ft <br />slotted <br />s•ction <br />;twist pack <br />ft. <br />Min 2" Annular EHD Seal Verified: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />E Yes ON° <br />To: <br />To: <br />To: <br />To: <br />casing <br />height <br />CHRISTY-BOX <br />COMPLETION <br /> C3nxir.:1 Surface <br />From: <br />From: <br />From: <br />From: <br /> SANIJOAQUIN <br />9111:0' ') —COUNTY <br />Greatness grows here. <br />Date: 42-21' 21 Inspector: /f/keeill <br />Facility Address: <br />Well Address: gO• ilitDev4gedef4*/16/4ed <br />WP#X 9/f5-3 We11#: <br />Soil Boring#: <br />Drilling Company: {cor,cio 600,4"...441- <br />Driller Onsite: /24 fri,--"ktetr6" <br />Consultant: /6 ef 1 4 <br />G elS-rtmikt: kitiory <br />Public Water System Onsite: E Yes ENo <br />Domestic Well Onsite: E Yes El N o <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes lilNo <br />SPOILS <br />Contamination Noted: El Yes ElNo <br />If yes, spoils storage Location: <br />Covered: El Yes ENo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: <br />LI Well Installation El Well Destruction <br />El Boring Installation EBoring Destruction <br />METHOD USED <br />El Pressure Grout EOver Drill <br />E Gravity ETremie E0ther: <br />Water <br />gallons <br />Cement 471b <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 s 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 />Environmental Health Department <br />CONSTRUCTION <br />Total Depth: 61 <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 />te 1 1§r40/16/2017 <br />Monitoring Well/Soil Boring Inspection Report <br />6 ea- <br />CelY/Sru—X04- 0.- <br />54**/ Al.t 2.3 <br />,- <br />Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com 1868 E. Hazelton Avenue I