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SAN JOAQUIN <br />COUNTY <br />Greatness grows herr . <br />Environmental Health Department <br />ElNo CI Stove Pipe COMPLETION lilChristie Box Public Water System Onsite: I=1 Yes <br />casing <br />height <br />Boring Destruction CI Boring Installatio <br />METHOD USED <br />1868 E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 6/1 /2.i Inspector: <br />Facility Address: 5/5 6. <br />Well Address: <br />wp# OD 4 201 9 Well#: <br />Soil Boring#: 6 i ea, 8 It /3-6 <br />Drilling Company: 1r-y-D—Con <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes lilNo <br />To: <br />To: <br />To: <br />To: <br />ate 10. If. <br />yese. • <br />Domestic Well Onsite: El Yes lilNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: I=1 Yes ON° 6/: go I <br />62: <br />Covered: 0 Yes LIN° gq <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: I I 5 f-1 <br />Depth to Water: e'%-- g <br />Grout Material: 47.16a-- <br />Gallons of Grout Used: "-SO 9 <br />LI Well Installation ElWell Destruction <br />CHRISTY-80X <br />cowtrnoN <br />LI Yes li1No <br />If yes, spoils storage Location: <br />66' <br />Ground Surlacs <br />ft. <br />ft <br />Feet <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen <br />Slot Size: <br />CI Pressure Grout DOver Drill <br />154 411, W <br />Gravity XTremie DOther: <br />Water <br />gallons <br />Cem entt91 <br />Bags <br />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 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 />10,1 <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 />Ylo/P --tavtj2 eixy) <br />10/16/2017 <br />slotted <br />a•cdon <br />ft. <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />.- <br />ABOVE•GROUND <br />COMPLETION <br />From: <br />From: <br />From: <br />From: