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Covered: <br />If yes, material: <br />GROUTING or DESTRUCTION Total De thoq6'—"C-4 <br />Depth to Water: • <br />Grout Material: <br />Gallons of Grout Used: <br />Yes ENo <br />A ...,„tl!jpAQUIN <br />, <br />NTY - <br />F....1.e.irc;-/ Greatness 9rows here <br />Environmental Health Department <br />Monitoring Well/Soil <br />'5/23 -/2 1 Date Inspector: <br />e'— <br />Facility Addressio <br />Well Address: <br />WP# ci-i 09 <br />Soil Boring#: cfb <br />Drilling Company: -t--/,0/1.-D.-br01/1 <br />Driller Onsite`.—OCIAikily <br />Consultant: <br />Geologist: <br />Boring Inspection Report <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />Oc_ <br />Well#: <br />Min 2" Annular EHD Seal Verified: 0 Yes 0No <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: 0 Yes EN° COMPLETION 0 Stove Pipe 0Christie Box <br /> <br />Domestic Well Onsite: 0 Yes 0No casing <br />height <br /> <br />If yes, location and distance: <br /> <br />SAMPLING <br />Holding Temperature: <br />Method: <br /> <br />ABOVE-GROUND <br />COMPLETION <br /> <br />cmstsTy-Box <br />COMPLETION <br /> <br />Ground Surface <br /> <br />Screening Method: <br />Verified Chain of Custody: El Yes IIINo <br />SPOILS <br />Contamination Noted: LI Yes CINo <br />If yes, spoils storage Location: <br />Well Installation 111 Well Destruction <br />0Boring Installatio Boring Destruction <br />METHOD USED <br />Pressure Grout 00ver Drill <br />c:Cravity 0Tremie 00ther: <br />Water <br />gallons <br />Cemen(4.111.)) <br />Bags <br />Water <br />gallons <br />Cement Sub <br />Bags <br />Thickest Thinnest 4 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 a <br />lo 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 />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 />Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com 1868 E. Hazelton Avenue