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casing <br />height <br />ABOVE-GROUND <br />C:40 PrIPLETION CMS/STY-60X <br />COMPLETION <br />COMPLETION El Stove Pipe GIChristie Box <br />Ground Sulaca <br />grout <br />ft <br /> ft <br />ft <br />slotted <br />aecdon <br />gravel pack <br />ft. ft <br /> SANAOAQUIN <br />COUNTY <br />4•trir Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: 8tilig Inpector: SWe-ANIrti..A <br />Facility Address: /-1 9 E 11 411 St / Taw) <br />Well Address: <br />WP# Op 3q Well#: <br />1A1 1-1 <br />Drilling Company: 6 <br />Driller Onsite: <br />Consultant: <br />Geologist: t2-4 CkL Moi <br />Public Water System Onsite: 0 Yes No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: Yes ON° <br />SPOILS <br />Contamination Noted: 0 Yes LIN° <br />If yes, spoils storage Location: <br />Covered: 0 Yes IllNo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: Z0 -et- <br />Depth to Water: <br />Grout Material: 1\-.LEAt Ce..NYULAA:t <br />Gallons of Grout Used: <br />OWell Installation IWell Destruction <br />111Boring Installation oring Destruction <br />METHOD USED <br />DPressure Grout 41Over Drill <br />'tGravity 0Tremie 1110ther: <br />Water <br />gallons <br />Cement 47 1b <br />Bags <br />Water <br />gallons <br />Cement 94Ib <br />Bags <br />Thickest Thinnest # 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 k 30 <br />CP 10 20 4 20 40 <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 a <br />CONSTRUCTION H s A- <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: LI Yes ONo <br />To: <br />To: <br />To: <br />To: <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% Mik,n MIX <br />Bentonite per 47 lb 1.41 -2.4'T <br />Bentonite per 94 lb 2.82 4.7 <br />Soil Boring#: <br />Yes EN° <br />Screen Length From: <br />Wilter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <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.sjcehd.com