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ABOVE-GROUND <br />CO MP LET10 N <br />4t4k)ce-3' <br />SA6JOAQUIN Environmental Health Department <br />COUNTY - <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Date:I InspectoriVM 0— 4 - <br />Facility Address: tgi Li 7 (144_ r elt y <br />Well Address: <br />WP # 0 0 9 6 I (2 Well#: <br />Soil Boring#: .6 ( <br />Drilling Company: ttk Leirr) ; I/tee/1-i <br />Driller Onsite: <br />Consultant: A vt-ee4-; <br />Geologist: <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: E Yes ENo <br />To: <br />To: <br />To: <br />To: <br />Screen Length From: <br />Filter Pack <br /> <br />From: <br />Bentonite From: <br />Grout <br /> <br />From: <br />Public Water System Onsite: E Yes ENo COMPLETION 0 Stove Pipe EChristie Box <br /> <br />Domestic Well Onsite: 0 Yes EINo <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: <br /> <br />El Yes ENo <br />SPOILS <br />Contamination Noted: E Yes El No <br />If yes, spoils storage Location: <br />Covered: E Yes ENo <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 3 34-4 <br />Depth to Water: 1/1/0 <br />Grout Material: <br />Gallons of Grout Used: "-• 0.0 <br />Ii Well Installation EWell Destruction <br />EBoring Installation <br />METHOD USED <br />oring Destruction <br /> <br />EPressure Grout EOver Drill <br />yLGravity errOe ElOther: <br />Water <br />gallons <br />Cement 47Ib <br />Bags <br />Water <br />gallons <br />Cemen9:..L. <br />Bag <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 />casing <br />height <br />CHRISTY-BOX <br />compLE—noN <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 />468-3420 I F 209 464-0138 I www.sjcehd.com 1868 E. Hazelton Avenue I Stockton, California 95205 I 1 2