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SAN JOAQUIN <br />COUNTY <br />Greatness grows herr <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />CONSTRUCTION <br />Soil Boring#: <br />Drilling Company: <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />EN° <br />COMPLETION El Stove Pipe <br /> <br />EINo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes ON° <br />SPOILS <br />Contamination Noted: D Yes E No <br />If yes, spoils storage Location: <br />Covered: CI Yes DNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: no Wadker <br />Grout Material: OPICiir CONV,Af <br />Gallons of Grout Used: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Date: 1\ 2.422- Inspector: <br />Facility Address: <br />Well Address: <br />WP# 004 6.-5 We11#: <br />Ucil <br />la be -ti_u141 <br />Public Water System Onsite: D Yes <br />Domestic Well Onsite: LI Yes <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: L Yes ONo <br />Screen Length From: To: <br />pieccjes Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />casing <br />height <br />C4-IFIISTY-BOX <br />COMPLETION <br />EIChristie Box <br />ft. <br />ft <br />slotted <br />sec-on <br />ft. <br />ElWell Installation LI Well Destruction <br />lilBoring Installation .Boring Destruction <br />METHOD USED <br />EPressure Grout DOver Drill <br />X..Gravity L1Trejj. DOther: <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet Screen Feet <br />Slot Size: <br />Water //f&rnent <br />gallons <br />47Ib <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest # Bags <br />2.5 5 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 />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