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Monitoring Well/Soi Date: Inspector-sZ, Alm Facility Address: Well Address: /27/ 4--d /4/1'? WP# 67P&0y-'q Well#: Soil Boring#: Drilling Company: ['//•+c. Driller Onsite: A411ke AJce—'L- Gy Consultant: Coy-.�v�fvn� Geologist: Environmental Health Department Boring Inspection Report CONSTRUCTION Total Depth: Drilling Rig Type: Min 2" Annular EHD Seal Verified Screen Length From Filter Pack From Bentonite From Grout From Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe Domestic Well Onsite: ❑ Yes ❑No If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method: Verified Chain of Custody: ❑ Yes ❑No wnll q Contamination Noted: ❑ Yes El No If yes, spoils storage Location: Covered: ❑ Yes ❑ No If yes, material: i GROUTING or DESTRUCTION Total Depth: 5� Depth to Water: Grout Material tic` Gallons of Grout Used: 9af ❑Well Installation ❑Well Destruction El Boring Installation YBoring Destruction METHOD USED ❑Pressure Grout ❑Over Drill �� ❑ Gravity TpTremie El Other: Z'1571 Water allons SAN-JOAQUIN Water vallons —COUNTY— Thickest Thinnest Greotness'grows her,_ Monitoring Well/Soi Date: Inspector-sZ, Alm Facility Address: Well Address: /27/ 4--d /4/1'? WP# 67P&0y-'q Well#: Soil Boring#: Drilling Company: ['//•+c. Driller Onsite: A411ke AJce—'L- Gy Consultant: Coy-.�v�fvn� Geologist: Environmental Health Department Boring Inspection Report CONSTRUCTION Total Depth: Drilling Rig Type: Min 2" Annular EHD Seal Verified Screen Length From Filter Pack From Bentonite From Grout From Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe Domestic Well Onsite: ❑ Yes ❑No If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method: Verified Chain of Custody: ❑ Yes ❑No wnll q Contamination Noted: ❑ Yes El No If yes, spoils storage Location: Covered: ❑ Yes ❑ No If yes, material: i GROUTING or DESTRUCTION Total Depth: 5� Depth to Water: Grout Material tic` Gallons of Grout Used: 9af ❑Well Installation ❑Well Destruction El Boring Installation YBoring Destruction METHOD USED ❑Pressure Grout ❑Over Drill �� ❑ Gravity TpTremie El Other: Z'1571 Water allons Cent 471 Water vallons Cement 941b Bags Thickest Thinnest Jt Bags Thickest Thinnest 9Bags 2.5 5 1 5 10 1 5 10 2 10 20 2 7.5 15 3 15 30 3 10 20 4 20 40 4 12.5 25 5 25 so 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 8 ❑ Yes ❑No To: To: To: To: ❑Christie Box —ft. MATERIALS/DEVELOPMENT Casing Type: Blank Feet Slot Size: Bags of Cement: Bags Sand/Gravel: Type/Brand of Bentonite: Filter Pack Type/Size: Type of Method: ft. Screen Feet Bentonite/Cement Mix 3% Mix 5% Mix Bentonite per 47 Ib 1.41 2.47 Bentonite per 94 Ib 2.82 4.7 10/16/2017 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com z