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COMPLETION D Stove Pipe D Christie Box <br />Min 2" Annular EHD Seal Verified: El Yes <br />Screen Length From: To: <br />Filter Pack From: To: <br />Bentonite From: To: <br />Grout From: To: <br />casing <br />height <br />CHAMTY-BOX <br />COMPLETION <br /> ft <br />El No <br />N OQINSAJAU <br />l <br /> <br />( <br />Date: 2 [3/2-4) Inspectorl - A-• <br />Facility Address: V -Ic I 6. ea...c.,ift -Ts/ 0.44d <br />Well Address: <br />WP# VO4 (31,‘ Well#: <br />Soil Boring#: a -18 6 <br />Drilling Company: Co-Sco-d.e_ Dr--;114i1i <br />Driller Onsite: COlfoin <br />Consultant: 14 (A. 1-1- q if — 1-; 1 s- FoyinarS <br />Geologist: 1040-rial <br />Public Water System Onsite: 111 Yes D No <br />Domestic Well Onsite: El Yes ON° <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: El Yes LII No <br />SPOILS <br />Contamination Noted: 0 Yes 0 No <br />If yes, spoils storage Location: <br />Covered: D Yes 111 No <br />If yes, material: 61 4 4c <br />GROUTING or DESTRUCTION Total Depth: 39, 2S <br />Depth to Water: ,26. <br />Grout Material: <br />0Well Installation El Well Destruction <br />OBoring Installation oring Destruction <br />METHOD USED <br />Li Pressure Grout D0ver Drill <br />159 <br />‘11remie 00ther: <br />Water <br />gallons <br />Cemen 47 lb <br />Bag <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest # Bags Thickest Thinnest tt 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 s <br />15 30 6 30 60 6 <br />17.5 35 7 35 70 7 <br />20 40 8 40 80 8 <br />Environmental Health Department <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: 1-isA <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank 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 % Mix <br />Bentonite per 47 lb 1.41 <br />Bentonite per 94 lb 2.82 4.7 <br />cedruviA.4 <br />Gallons of Grout Used: ) 60 5 <br />Gravity <br />iaik`) COUNTY <br />Greatness grows here <br />Monitoring Well/Soil Boring Inspection Report <br />Screen Feet <br />S 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