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COMPLETION LI Stove Pipe <br />casing <br />height <br />EChristie Box <br />CHAZTY-80X <br />COMPLETIpt4 <br />SAN JOAQUIN Environmer ' Health Department <br />COUNTY <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date:/h/2—/I Inspect r: f4 fr-Vrt, CONSTRUCTION <br />Facility ddress: 10 pi Id tp„,141 <br />Well Address: <br />WP# 1--Y0 0 3 7 7 f' went <br />Soil Boring#: ttp , ei Min 2" Annular EHD Seal Verified: <br /> <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />Total Depth: <br />Drilling Rig Type: <br />Drilling Company: 6 ra:c <br />Driller Onsite: iCt'eAre- (TO) <br />Consultant: <br />Geologist: \ 0 LA, 76-01 I ri_GtA_A. <br />Yes ONo <br />To: <br />To: <br />To: <br />To: <br />Public Water System Onsite: L Yes EINo <br />Domestic Well Onsite: LI Yes DNo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: 111 Yes ON° <br />SPOILS <br />Contamination Noted: 0 Yes EN° <br />If yes, spoils storage Location: <br />Covered: 0 Yes ONo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: <br />Grout Material: <br />Depth to to Water: <br />c'S—f <br />Gallons of Grout Used: / 0 <br />El Well Installation <br /> <br />OWell Destruction <br />OBoring Installation V2F3oring Destruction <br />METHOD USED <br />0Pressure Grout DOver Drill <br />ri Gravity <br /> <br />releremie DOther: <br />Water <br />gallons <br />Cement 471b <br />Bags <br />Water <br />gallons <br />Cement 94 lb <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 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 />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 />C Ci 3A, <br />1868 E. Hazelton Avenue Stoektofi, California 95205 I T 209 468-3420 I F 209 464-0138 [ www.sjcehd.com <br />10/16/2017