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Yes 0 No Verified Chain of Custody: <br />SPOILS <br />Wfrvi <br />re) <br />EWell Installation LI Well Destruction <br />El Boring Installation FiBoring Destruction <br />METHOD USED <br />El Gravity remie DOther: <br />COMPLETION El Stove Pipe LI Christie Box <br />casing <br />height <br />SAN JOAQUIN <br />--COUNTY <br />Greatness grows her, <br />Monitoring Well/Soil Boring Inspection Report <br />Environmental Health Department <br />Date: Inspector: 1,-Z9-2/ Inspector: /v4cS6-6,64 <br />Facility Address: o /kJ f & I •,41/041 <br />Well Address: <br />W P# 9/6f Well#: <br />Soil Boring#: az. <br />Drilling Company: 66:5- 40cs-40-4ee <br />Driller Onsite: <br />Consultant: ,/ifeim_ <br />Geologist: 5,fr <br />Public Water System Onsite: 1=1 Yes 111 N o <br />Domestic Well Onsite: 0 Yes lilNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: 0 Yes 111 No <br />If yes, spoils storage Location: <br />Covered: CI Yes 1=1No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: /2 <br />Grout Material: Need ce/Poet <br />Gallons of Grout Used: <br />0 Pressure Grout lilOver Drill <br />Water <br />.gait6F <br />Cement 47Ib <br />..--Birgr--- <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Test Thinnest #Bags Thickest Thinnest #Bags <br />2.5 5 1 5 10 1 <br />s 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 />_ft <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes ON° <br />To: <br />To: <br />To: <br />To: <br />ABOVE-GROUND <br />COMPLETION CHRtSTY-BOX <br />COMPLETION <br /> C3rand Surfacs <br />grout <br />__ft <br />ft <br />• • • <br />cravat pack <br />ft. <br />A <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <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 />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