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SANAOAQUI, <br />COUNTY <br />Greatness grows here. " <br />Environmc al Health Department <br />0 Yes No Public Water System Onsite: <br />El Yes Li No Verified Chain of Custody: <br />SPOILS <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 2.-9 V <br />Facility Address: P(I() C, 7 e I 4-, iN <br />Well Address: <br />WP# Well#: <br />Soil Boring#: 41-6 IA) jer cf /VI p <br />Drilling Company: ai 1:Aarr% ; 11.,..$K <br />Driller Onsite: CI& / •-‘ <br />Consultant: CC A r- <br />Geologist: LA c <br />Domestic Well Onsite: 0 Yes No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Contamination Noted: 0 Yes ENo <br />If yes, spoils storage Location: <br />Covered: 10 Yes El No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Depth to Water: q 3 <br />Grout Material: 7.) eaI C e en <br />Gallons of Grout Used: <br />EWell Installation El Well Destruction <br />Boring Installation ?iBoring Destruction <br />METHOD USED <br />Pressure Grout 00ver Drill <br />Oil Gravity 1)4(Tremie 00ther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest t Ila s Thickest Thinnest g Bags <br />2.5 1 5 10 1 <br />5 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 />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 CI Stove Pipe <br />casing <br />height <br />0Christie Box <br />CI-GRISTY-BOX <br />COMPLE110N <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />From: <br />From: <br />From: <br />From: <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 />Inspector: ne_ I:s-so ; <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />I,