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casing <br />height <br />COMPLET19N <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: 0 Yes 0No <br />To: <br />To: <br />To: <br />To: <br />COMPLETION 0 Stove Pipe El Christie Box <br />Ground Surf acs <br />grout <br />4r <br />It. <br />ft <br />ft <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />_ft. <br />stongd <br />sicto n <br />From: <br />From: <br />From: <br />From: <br />SAN,JOAQUIN <br />COUNTY <br /> Environmental Health Department <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: V\ VIA Inspector: <br />Facility Address: /521\\ <br />Well Address: 5 <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: c,\ <br />Geologist: <br />Public Water System Onsite: El Yes No <br />Domestic Well Onsite: <br /> <br />111 Yes ONo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: CI Yes EINo <br />SPOILS <br />Contamination Noted: CI Yes VNo <br />If yes, spoils storage Location: <br />Covered: El Yes r‘No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:VO <br />Depth to Water: <br />Grout Material: N <br />Gallons of Grout Used: <br />Li Well Installation <br />EBoring Installation <br />METHOD USED <br />El Pressure Grout ElOyer Drill <br />El Gravity <br /> 4remie DOther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest veil t/ Thickest Thinnest #Balgs <br />2.5 '5 <br />1 12g)s <br />5 10 1 <br />5 10 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 />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 />i\-5S"D (•-• • <br />Well#: <br />OWell Destruction <br />Boring Destruction <br />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-3420 I F 209 464-0138 I www.sicehd.com