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Eno, SAN�JOAQUIN I .—COUNTY— Greatness grov.s lyre. Environmental Health Department Public Water System Onsite: Yes ❑No Domestic Well Onsite: ❑ Yes ❑No If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method: Verified Chain of Custody: ❑ Yes ❑No SPOILS Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Covered: ❑ Yes ❑ No If yes, material: / GROUTING or DESTRUCTION Total e the Depth to Water: G out Material COMPLETION ❑ Stove Pipe El Yes El No To: To: To: To: ❑Christie Box n, r Gallons of Grout Used: MATERIALS/DEVELOPMENT "-" 957;:� Casing Type: ❑Well Installation ❑Well Destruction Blank Feet ❑Boring Installation/ oring Destruction Slot Size: � Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill ❑ Gravity *remie ❑Other: i Water allons Monitor�i/ng Well/Soil Boring Inspection Report Date ff// Z � L —Inspector." `� CO C CONSTRUCTION Premise Address: Cement 94 lb Ba s WP#: Total Depth: Well#: Drilling Rig Type: Soil Boring#: '– Min 2" Annular Seal Verified: Drilling Company: 5 Driller Onsite: Screen Length From: Consultant: Filter Pack From: Geologist: Bentonite From: 20 Grout From: Public Water System Onsite: Yes ❑No Domestic Well Onsite: ❑ Yes ❑No If yes, location and distance: SAMPLING Holding Temperature: Method: Screening Method: Verified Chain of Custody: ❑ Yes ❑No SPOILS Contamination Noted: ❑ Yes ❑No If yes, spoils storage Location: Covered: ❑ Yes ❑ No If yes, material: / GROUTING or DESTRUCTION Total e the Depth to Water: G out Material COMPLETION ❑ Stove Pipe El Yes El No To: To: To: To: ❑Christie Box n, r Gallons of Grout Used: MATERIALS/DEVELOPMENT "-" 957;:� Casing Type: ❑Well Installation ❑Well Destruction Blank Feet ❑Boring Installation/ oring Destruction Slot Size: � Bags of Cement: METHOD USED Bags Sand/Gravel: ❑Pressure Grout ❑Over Drill ❑ Gravity *remie ❑Other: i Water allons Cement 471b Bas Water gallons Cement 94 lb Ba s Thickest Thinnest It Bags Thickest Thinnest #Bags 2.5 5 1 5 10 1 5 10 2 10 20 2 7.5 15 15 30 3 1 10 20 r4-1 20 40 1 4 12.5 25 5 25 50 5 15 30 6 30 60 6 17.5 35 7 35 70 7 20 40 8 40 80 Type/Brand of Bentonite: Filter Pack Type/Size: Type of Method: 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 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com