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COMPLETION <br />ABOVE-GROUND <br />COMPLETION <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank 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% MixtD 11c <br />Bentonite per 47 lb 1.41 2 <br />..4!ir <br />Bentonite per 94 lb 2.82 4.7 <br />Screen Feet <br />4 6-0 -co 0,76 2-8_ <br />6s 15./o -6°K LY3-s- 4.7 3 <br />-5 g t;t9 3 ',vitae( 4, 4 e -I V ' 74- cidi-4.4c c <br />11,,F.Dar%'' <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows her€ <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date. Li Inspector: . CONSTRUCTION <br />Facility Address: I $OD W. on 1Zsio-414 <br />Well Address: <br />WP#O3 4I6as Well#: <br />"./ Soil Boring#: 7 — 10 <br />Drilling Company: Cp3 Ceit-c112__ <br /> <br />Cp 1 -1791/1 <br />H- LAI 't rei ll kly ettl-CS <br />Ck.c• <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: Yes ONo <br />Screen Length From: To: <br />Filter Pack <br /> <br />From: To: <br />Bentonite From: To: <br />Grout From: To: <br />Public Water System Onsite: 1111 Yes IIINo <br />Domestic Well Onsite: LIiYes LI No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: I=1 Yes EINo <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br /> <br />Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 10 <br />Depth to Water: <br />Grout Material: <br />Gallons of Grout Used: - <br />LI Well Installation El Well Destruction <br />CI Boring Installation oring Destruction <br />METHOD USED <br />OPressure Grout 1110ver Drill <br />i6Gravity igTremie 00ther: <br />to-l• <br />LI Stove Pipe IIIChristie Box <br />Ground Sudan <br />ft <br />t. <br />slotted <br />secdon <br />ft. <br />0'1' .2s ' <br />et 02.s <br />Yes 111No <br />Yes <br />casing <br />height <br /> <br />crossrr-sox <br />COMPLETION <br />Water <br />gallons <br />Cemt, Water <br />gallons <br />Cement 941b <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 SO 5 <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Co 10.1 6/0 fie-f <br />10/16/2017 <br />/CoIri nal", <br />1868 E. Hazelton Avenue I Sto&ton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com