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ABOVE-GROUND <br />COMP LETIO N <br />_f t <br />slottakci <br />saclo n <br />ft. <br />CHRISTY-BOX <br />COMPLETION <br />gNkrccrs.)) <br />SAN,,,JOAQUIN <br />COU NTY— <br />Greatness grows here, <br />Environmental Health Department <br />Monitoring Well/Soil <br />Date: (9\1,0Vuo2Jx. Inspector: &Az:12^ (-.2) <br />Facility Address: \-\\‘`-\\ 4\""\ <br />Well Address: co <br />WP# \\\St\.\ We11#: Lc\ <br />Soil Boring#:C.,- 5 <br />Drilling Company: - <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Boring Inspection Report <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: LI Yes ON° <br />To: <br />To: <br />To: <br />To: <br />From: <br />From: <br />From: <br />From: <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />COMPLETION Public Water System Onsite: 0 Yes 1i/No <br />Domestic Well Onsite: 0 Yes V.No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: LI Yes li1No <br />SPOILS <br />Contamination Noted: 0 Yes ENo <br />If yes, spoils storage Location: <br />Covered: E Yes EN° <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: <br />Grout Material: N <br />Gallons of Grout Used: <br />EWeIl Installation LIWell Destruction <br />E Boring Installation Boring Destruction <br />METHOD USED <br />E Pressure Grout DOver Drill <br />LI Gravity Tremie DOther: <br />LI Stove Pipe EIChristie Box <br />casing <br />height <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 />5 <br />Water <br />gallons <br />Cement 47 lb <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest #Bags <br />2.5 ) <br />10 lila <br />5 io 3. <br />5 10 20 2 <br />7.5 15 3 15 30 3 <br />10 20 4 20 0 4 <br />12.5 25 5 25 0 5 <br />15 30 6 30 N 6 <br />17.5 35 7 35 78 7 <br />20 40 a 40 N 8 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />P @-‘07 C2A1 "fik) <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 />l`c-tb '4-4C <br />Lm"- W•F